Impact of COVID-19 infection among cancer patients treated at the Los Angeles County Medical Center

Abstract

We conducted a retrospective analysis of cancer patients who presented to the hospital with COVID-19 infection at a safety-net hospital in Los Angeles, California, from March 2020 to June 2020. From a list of 1,163 COVID-19+ adult patients, we selected the first 50 patients with malignancy for a preliminary analysis. There were 23 males (46.0%) and 27 females (54.0%); the median age was 60.5 years (IQR 47 - 72). Thirty-nine (78.0%) of the patients were Hispanic. The most prevalent cancers were genitourinary (14, 28.0%), hematologic (11, 22.0%), and gastrointestinal (10, 20.0%). Twenty-one (42.0%) patients had active disease at COVID-19 diagnosis, while 25 (50.0%) had no evidence of disease (NED), and 4 (8.0%) were unknown. Over 1 in 3 admitted patients experienced a "severe outcome," which was defined as critical level care (14, 34.1%), use of vasopressors (9, 22.0%), intubation (8, 19.5%), or death (5, 12.2%). Patients with severe outcomes were found to have statistically higher values of absolute neutrophil count (p = 0.005), aspartate aminotransferase (p = 0.049), high-sensitivity C-reactive protein, (p = 0.001) and lactate dehydrogenase (p = 0.040) on admission. Overall survival (OS) was not statistically different between those with hematologic versus solid malignancy nor between those with active disease versus remission (both p>0.05). Thirteen (81.3%) of the 16 patients who had cancer treatment in 2020 experienced delays in cancer therapy. Additional cases are being evaluated as the pandemic continues with the goal of identifying areas for potential intervention to improve outcomes in this at-risk population.

Keywords: Cancer; Coronavirus; Covid-19; Malignancy; Pandemic.

Fig. 1

PRISMA Diagram Depicting Identification and Selection of Eligible Patients.

Fig. 2

Correlation of Individual Treatments to Likelihood of Severe Outcomes Denoted by Pearson r Coefficient.

Fig. 3

Kaplan-Meier Survival Curve for All Patients with Cancer Diagnosis and Concurrent COVID-19 Infection. Patients were censored at the time of discharge or death, as denoted by ticks on the curve. Patients who were not admitted or were discharged on the same day of admission were excluded from this analysis.