Critically ill patients with cancer, COVID-19 at high risk for severe disease, mortality

New data presented at the virtual CHEST Annual Meeting add to the growing body of evidence of the increased risk for mortality and severe disease in patients with cancer and COVID-19.

“The typical stereotype within the medical community is that cancer patients are particularly susceptible to worst outcomes just due to their cancer diagnosis alone,” Michael K.M. Dang, MD, fellow in the department of anesthesiology and critical care medicine at Memorial Sloan Kettering Cancer Center, said during a presentation. “It stands to reason that our frail cancer population would be much more susceptible to a devastating result from COVID-19.”

Researchers evaluated clinical characteristics and outcomes of 89 adults (mean age, 64 years; 58% men; 66% white; mortality probability model score, 42%) with active or a recent history of cancer and confirmed COVID-19 infection causing acute hypoxemic respiratory failure admitted to two ICUs at Memorial Sloan Kettering Cancer Center from mid-March through June. Researchers assessed baseline demographics to evaluate key identifiers and ICU variables reflective of overall mortality for the patient population.

Half of patients had hypertension, 28% had diabetes, 53% had a smoking history and 15% had three or more major comorbidities. Cancer diagnoses among the population showed that 57% of patients had solid tumors, including lung, breast, prostate and gastrointestinal cancers, and 43% had hematologic cancers, including mainly leukemia and lymphoma. Forty-eight percent of patients were on active cancer treatments in the last 90 days.

At ICU admission, 9% of patients had neutropenia. Dang highlighted a large discrepancy in interleukin-6; those who received mechanical ventilation had higher IL-6 levels on admission (468.4) vs. those who were not intubated (120.8).

Approximately two-thirds of patients required mechanical ventilation. Nearly half (45%) required vasopressors and 8% required continuous renal replacement therapy. At the beginning of the COVID-19 pandemic, hydroxychloroquine and azithromycin were primary treatments in 73% and 60% of patients, respectively, but a rise in experimental medications after emergency authorization use led to remdesivir used in 19%, convalescent plasma in 18% and steroids in 75%.

Forty percent of patients died; of those, 47% had hematologic cancers and 27% had solid tumors. Among patients who required mechanical ventilation, tracheostomy was performed in 24% and one-quarter of patients died by the end of the study period. Neutropenia conferred a 75% mortality rate, Dang said, noting that results showed “a clear demarcation” that those who were neutropenic on ICU admission had a higher likelihood of mortality.

“This data set showed us that a higher mortality rate is conferred with any diagnosis of cancer on ICU admission for respiratory failure, but COVID-19 and cancer is not a death sentence,” Dang said. “Patients do have survivorship and reasonable outcomes. And, as such ... a trial of progressive ICU management is clinically warranted.”

Reference:

Dang MKM, et al. Chest. 2020;doi:10.1016/j.chest.2020.08.562.