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A Multicentre Study of 2019 Novel Coronavirus Disease Outcomes of Cancer Patients in Wuhan, China

By Hongyan Zhang, Linwei Wang, Yuanyuan Chen, Xiaokun Shen, Qun Wang, Youqin Yan, Yi Yu, Qiuji Wu, Yahua Zhong, Melvin L.K. Chua, Conghua Xie

Posted 26 Mar 2020
medRxiv DOI: 10.1101/2020.03.21.20037127

OBJECTIVETo study clinical characteristics of cancer patients infected with COVID-19. Outcomes of cancer patients were the key contents of this study. DESIGNRetrospective study. SETTINGFour designated COVID-16 hospitals in Wuhan, Hubei province, China. PARTICIPANTSMedical records of 67 cancer patients admitted to hospitals between Jan 5, 2020 to Feb 18, 2020 were included. MAIN OUTCOME MEASURESDemographic, clinical, laboratory, radiological and treatment data were collected. Survival data of the cohort was cut-off on Mar 10, 2020. RESULTSOf the 67 patients (median age: 66 years), the median age of patients who had severe illness was older than that of patients who had mild symptoms (P<0.001). Forty-three (64.2%) patients had other concurrent chronic diseases, and the proportion of severe patients had co-morbidities was higher than patients with mild disease (P=0.004). Twenty-three (34.3%) patients were still at the anticancer treatment phase, but no tumour progression and recurrence was observed for all the patients during the treatment of COVID-19 pneumonia. About 70% of these patients had fever (n=53, 79.1%) and/or cough (n=50, 74.6%). Lymphocytopenia was the main laboratory finding accompanying increased C-reactive protein and procalcitonin in cancer patients, especially in severe cases. By Mar 10, 2020, 18 (26.9%) patients died from COVID-19, and 39 (58.2%) patients have been discharged. The median age of survivors was younger than that of deaths (P=0.014). Lung cancer (n=15, 22.4%) with COVID-19 was the most common cancer type and accounted for the highest proportion COVID-19 resulted deaths (33.3%, 5/15). We observed a tendency that patients at the follow-up phase had a better prognosis than that at anticancer treatment phase (P=0.095). CONCLUSIONThis study showed COVID-19 patients with cancer seem to have a higher proportion of severe cases and poorer prognosis. The tendency of poor prognosis was more obvious in patients at anticancer treatment phase. We should pay more intensive attentions to cancer patients infected with COVID-19. FundingThis study was funded by Health Commission of Hubei Province Scientific Research Project (WJ2019H002) and Health Commission of Hubei Province Medical Leading Talent Project, and National Key Research and Development Program of China (2020YFC0845500). Role of the Funder/SponsorThe funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of interestThe authors declare no conflict of interest. Ethical statementApproval of the study protocol was obtained from the Institutional Ethics Committee of hospitals (No. 2020041). The study was undertaken according to the ethical standards of the World Medical Association Declaration of Helsinki. Research in contextO_ST_ABSWHAT IS ALREADY KNOWN ON THIS TOPICC_ST_ABSCancer patients are at higher risk of COVID-19 and more likely having severe disease than those without cancer. We searched PubMed for articles published up to Mar 18, 2020. Only 2 articles that highlighted the risk of cancer patients infected with COVID-19 were identified. The reports were limited by small cases, inadequate clinical and prognostic information. Therefore, an extended study with more cases to reveal the characteristics and to investigate the prognosis of cancer patients with COVID-19 is warranted. WHAT THIS STUDY ADDSThis study involved 67 COVID-19 patients with cancer, the largest of its kind. We confirmed that COVID-19 patients with cancer had a higher proportion of severe cases and poorer prognosis than COVID-19 patients without cancer. We observed a tendency that patients at the follow-up phase had a better prognosis than those who were at anticancer treatment phase. Deaths had older median age and more co-morbidities than and survivors.

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