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Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study

2021; Elsevier BV; Volume: 22; Issue: 12 Linguagem: Inglês

10.1016/s1470-2045(21)00573-8

1474-5488

David J. Pinato, Josep Tabernero, Mark Bower, Lorenza Scotti, Meera Patel, Émeline Colomba, Saoirse Dolly, Angela Loizidou, John Chester, Uma Mukherjee, Alberto Zambelli, Alessia Dalla Pria, Juan Aguilar‐Company, Diego Ottaviani, Amani Chowdhury, Eve Merry, Ramón Salazar, Alexia Bertuzzi, Joan Brunet, Matteo Lambertini, Marco Tagliamento, Anna Pous, Ailsa Sita-Lumsden, Krishnie Srikandarajah, Johann Colomba, Fanny Pommeret, Elia Seguí, Daniele Generali, Salvatore Grisanti, Paolo Pedrazzoli, Gianpiero Rizzo, Michela Libertini, Charlotte Moss, Joanne Evans, Beth Russell, Nadia Harbeck, Bruno Vincenzi, Federica Biello, Rossella Bertulli, Raquel Liñan, Sabrina Rossi, M. Carmen Carmona-García, Carlo Tondini, María Laura Fox, Alice Baggi, Vittoria Fotia, Alessandro Parisi, Giampero Porzio, Maristella Saponara, Claudia Andrea Cruz, David García-Illescas, Eudald Felip, Ariadna Roqué, Rachel Sharkey, Elisa Roldán, Roxana Reyes, Irina Earnshaw, Daniela Ferrante, Javier Marco‐Hernández, Isabel Ruiz‐Camps, Gianluca Gaïdano, Andrea Patriarca, Riccardo Bruna, Anna Sureda, Clara Martínez-Vila, Ana Sánchez, Luca Cantini, Marco Filetti, Lorenza Rimassa, Lorenzo Chiudinelli, Michela Franchi, Marco Krengli, Armando Santoro, Aleix Prat, Mieke Van Hemelrijck, Nikolaos Diamantis, Thomas Newsom-Davis, Alessandra Gennari, Alessio Cortellini, Judith Swallow, Chris Chung, Gino Dettorre, Neha Chopra, Alvin Lee, Christopher C.T. Sng, Yien Ning Sophia Wong, Myria Galazi, Sarah Benafif, Palma Dileo, Grisma Patel, Anjui Wu, Alasdair Sinclair, Gehan Soosaipillai, Eleanor Jones, Nikolaos Diamantis, Uma Mukherjee, Amanda Jackson, Martine Piccart, Fanny Pommeret, Johann Colomba, E. Colomba-Blameble, Aleix Prat, Claudia Andrea Cruz, Roxana Reyes, Elia Seguí, Javier Marco‐Hernández, Josep Tabernero, Juan Aguilar‐Company, Isabel Ruiz‐Camps, María Laura Fox, David Garcia Illescas, Oriol Mirallas, Elisa Roldán, Anna Carbó, Isabel García, Rachel Wuerstlein, Ricard Mesı́a, Clara Maluquer, Francesca D’Avanzo, Giuseppe Tonini, Salvatore Provenzano, Valeria Tovazzi, Corrado Ficorella, Paola Queirolo, Raffaele Giusti, Francesca Mazzoni, Federica Zoratto, Marco Tucci, Rossana Berardi, Annalisa Guida, Sergio Bracarda, María Iglesias,

Childhood Cancer Survivors' Quality of Life

BackgroundThe medium-term and long-term impact of COVID-19 in patients with cancer is not yet known. In this study, we aimed to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. We also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection.MethodsOnCovid is an active European registry study enrolling consecutive patients aged 18 years or older with a history of solid or haematological malignancy and who had a diagnosis of RT-PCR confirmed SARS-CoV-2 infection. For this retrospective study, patients were enrolled from 35 institutions across Belgium, France, Germany, Italy, Spain, and the UK. Patients who were diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, and entered into the registry at the point of data lock (March 1, 2021), were eligible for analysis. The present analysis was focused on COVID-19 survivors who underwent clinical reassessment at each participating institution. We documented prevalence of COVID-19 sequelae and described factors associated with their development and their association with post-COVID-19 survival, which was defined as the interval from post-COVID-19 reassessment to the patients' death or last follow-up. We also evaluated resumption of systemic anti-cancer therapy in patients treated within 4 weeks of COVID-19 diagnosis. The OnCovid study is registered in ClinicalTrials.gov, NCT04393974.Findings2795 patients diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, were entered into the study by the time of the data lock on March 1, 2021. After the exclusion of ineligible patients, the final study population consisted of 2634 patients. 1557 COVID-19 survivors underwent a formal clinical reassessment after a median of 22·1 months (IQR 8·4–57·8) from cancer diagnosis and 44 days (28–329) from COVID-19 diagnosis. 234 (15·0%) patients reported COVID-19 sequelae, including respiratory symptoms (116 [49·6%]) and residual fatigue (96 [41·0%]). Sequelae were more common in men (vs women; p=0·041), patients aged 65 years or older (vs other age groups; p=0·048), patients with two or more comorbidities (vs one or none; p=0·0006), and patients with a history of smoking (vs no smoking history; p=0·0004). Sequelae were associated with hospitalisation for COVID-19 (p<0·0001), complicated COVID-19 (p<0·0001), and COVID-19 therapy (p=0·0002). With a median post-COVID-19 follow-up of 128 days (95% CI 113–148), COVID-19 sequelae were associated with an increased risk of death (hazard ratio [HR] 1·80 [95% CI 1·18–2·75]) after adjusting for time to post-COVID-19 reassessment, sex, age, comorbidity burden, tumour characteristics, anticancer therapy, and COVID-19 severity. Among 466 patients on systemic anti-cancer therapy, 70 (15·0%) permanently discontinued therapy, and 178 (38·2%) resumed treatment with a dose or regimen adjustment. Permanent treatment discontinuations were independently associated with an increased risk of death (HR 3·53 [95% CI 1·45–8·59]), but dose or regimen adjustments were not (0·84 [0·35–2·02]).InterpretationSequelae post-COVID-19 affect up to 15% of patients with cancer and adversely affect survival and oncological outcomes after recovery. Adjustments to systemic anti-cancer therapy can be safely pursued in treatment-eligible patients.FundingNational Institute for Health Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.