Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

Abstract

Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. SIGNIFICANCE: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access.This article is highlighted in the In This Issue feature, p. 1426.

Figure 1.

CONSORT diagram (top) and registry accrual (bottom) during the data collection period of March 17 to June 26, 2020. Red points represent included cases; blue points represent excluded cases. ¹Hydroxychloroquine (HCQ), azithromycin, remdesivir, high-dose systemic corticosteroids, tocilizumab, or other COVID-19 treatments; ²Only excluded if patient has a baseline autoimmune condition; ³Only excluded if patient has baseline chronic obstructive pulmonary disease, asthma, or HIV; ⁴Only excluded if patient has baseline HIV.

Figure 2.

Heat map of selected clinical factors stratified by treatment exposures. Coloration depicts the absolute departure from the average for that category; for example, patients with obesity were overrepresented in the tocilizumab exposure group by more than 16% of the average level of obesity in the total population (51% vs. 32%); patients with renal comorbidities were underrepresented in the remdesivir exposure group by 6% to 10% below the average level of renal comorbidities in the total population (9% vs. 18%). ^aPercentages add up to more than 100 because some patients had multiple malignancies; ^bIncludes patients enrolled in blinded randomized controlled trials, e.g., of remdesivir vs. placebo. NED, no evidence of disease.

Figure 3.

UpSet plot of treatment exposures. There are a total of 865 treatment exposures observed across 49 different patterns.

Figure 4.

Distribution of matched and unmatched cohorts stratified by exposure of interest (EOI). Negative controls are patients who did not have any reported COVID-19 treatment; positive controls are patients who had a treatment reported that did not include the EOI. EOI+, EOI with any other exposure; HCQ, hydroxychloroquine.