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Multicenter Study
. 2022 Jan 1;8(1):114-122.
doi: 10.1001/jamaoncol.2021.6199.

Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry

OnCovid Study Group; David J Pinato  1   2 , Meera Patel  1 , Lorenza Scotti  3 , Emeline Colomba  4 , Saoirse Dolly  5 , Angela Loizidou  6 , John Chester  7   8 , Uma Mukherjee  9 , Alberto Zambelli  10 , Alessia Dalla Pria  11 , Juan Aguilar-Company  12   13 , Mark Bower  11 , Ramon Salazar  14 , Alexia Bertuzzi  15 , Joan Brunet  16 , Matteo Lambertini  17   18 , Marco Tagliamento  17   18 , Anna Pous  19 , Ailsa Sita-Lumsden  5 , Krishnie Srikandarajah  5 , Johann Colomba  4 , Fanny Pommeret  4 , Elia Seguí  20 , Daniele Generali  21   22 , Salvatore Grisanti  23 , Paolo Pedrazzoli  24   25 , Gianpiero Rizzo  24 , Michela Libertini  26 , Charlotte Moss  27 , Joanne S Evans  1 , Beth Russell  27 , Nadia Harbeck  28 , Bruno Vincenzi  29 , Federica Biello  2 , Rossella Bertulli  30 , Diego Ottaviani  31 , Raquel Liñan  16 , Sabrina Rossi  15 , M Carmen Carmona-García  16 , Carlo Tondini  10 , Laura Fox  32 , Alice Baggi  22 , Vittoria Fotia  10 , Alessandro Parisi  33 , Giampero Porzio  34 , Paola Queirolo  35 , Claudia Andrea Cruz  20 , Nadia Saoudi-Gonzalez  12 , Eudald Felip  19 , Ariadna Roqué Lloveras  16 , Thomas Newsom-Davis  11 , Rachel Sharkey  11 , Elisa Roldán  12 , Roxana Reyes  20 , Federica Zoratto  36 , Irina Earnshaw  31 , Daniela Ferrante  3 , Javier Marco-Hernández  37 , Isabel Ruiz-Camps  13 , Gianluca Gaidano  38 , Andrea Patriarca  38 , Riccardo Bruna  38 , Anna Sureda  39 , Clara Martinez-Vila  40 , Ana Sanchez de Torre  41 , Rossana Berardi  42 , Raffaele Giusti  43 , Francesca Mazzoni  44 , Annalisa Guida  45 , Lorenza Rimassa  15   46 , Lorenzo Chiudinelli  10 , Michela Franchi  10 , Marco Krengli  47 , Armando Santoro  15   46 , Aleix Prat  20   48 , Josep Tabernero  49 , Mieke Van Hemelrijck  27 , Nikolaos Diamantis  9 , Alessandra Gennari  2 , Alessio Cortellini  1   34
Affiliations
Multicenter Study

Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry

OnCovid Study Group et al. JAMA Oncol. .

Abstract

Importance: Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined.

Objective: To test whether severity and mortality from COVID-19 among patients with cancer have improved during the course of the pandemic.

Design, setting, and participants: OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer.

Exposures: SARS-CoV-2 infection.

Main outcomes and measures: Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021).

Results: At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median [IQR] age, 68 [18-77] years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020; 12.5% (95% CI, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021 (all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 [60.3%] vs 564 of 1008 [56.1%]; P = .03), have at least 2 comorbidities (793 of 1626 [48.8%] vs 427 of 1008 [42.4%]; P = .001), and have advanced tumors (708 of 1626 [46.4%] vs 536 of 1008 [56.1%]; P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 [45.4%] vs 342 of 1008 [33.9%]; P < .001) and require hospitalization (969 of 1626 [59.8%] vs 418 of 1008 [42.1%]; P < .001) and anti-COVID-19 therapy (1004 of 1626 [61.7%] vs 501 of 1008 [49.7%]; P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti-COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak.

Conclusions and relevance: The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pinato reported receiving lecture fees from ViiV Healthcare, Bayer Healthcare, Bristol Myers Squibb, Roche, Eisai, and Falk Foundation; travel expenses from Bristol Myers Squibb and Bayer Healthcare; consulting fees from Mina Therapeutics, Eisai, Roche, DaVolterra, and AstraZeneca; and research funding (to institution) from MSD Pharma and Bristol Myers Squibb. Dr Zambelli reported receiving personal fees from Novartis, Lilly, Pfizer, AstraZeneca, ExactSciences, Merck, and Daiichi Sankyo outside the submitted work. Dr Bower reported receiving personal fees from Gilead, ViiV, Bristol Myers Squibb, and Merck speaker honoraria outside the submitted work. Dr Lambertini reported receiving speaker honoraria from and serving an advisory role for Roche, Novartis, AstraZeneca, Lilly, Pfizer, Takeda, and Sandoz outside the submitted work. Dr Prat reported receiving personal honoraria from Pfizer, Roche, MSD Oncology, Eli Lilly, and Daiichi Sankyo; travel, accommodations, and expenses paid by Daiichi Sankyo; research funding from Roche and Novartis; and consulting/advisory role for NanoString Technologies, Amgen, Roche, Novartis, Pfizer, and Bristol Myers Squibb. Dr Felip reported receiving research founding to institution by Pfizer and travel expenses from Lilly, Novartis, Pfizer, and Eisai. Dr Newsom-Davis reported receiving consulting/advisory role for Amgen, Bayer, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Eli Lilly, MSD Pharma, Novartis, Otsuka, Pfizer, Roche, and Takeda; speakers fees from AstraZeneca, MSD Pharma, Roche, and Takeda; and travel, accommodations, and expenses paid by AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Lilly, MSD Pharma, Otsuka, Roche, and Takeda. Dr Brunet reported serving a consulting/advisory role for MSD Pharma and AstraZeneca. Dr Parisi reported serving a consulting/advisory role for Takeda and Sanofi. Dr Tagliamento reported receiving travel grants from Roche, Bristol Myers Squibb, AstraZeneca, and Takeda; and honoraria as medical writer from Novartis and Amgen outside the submitted work. Dr Evans reported receiving personal fees from AstraZeneca, honorarium for educational work and nonfinancial support from Boehringer Ingelheim Conference Registration, nonfinancial support from Novartis Conference Registration, and nonfinancial support from Roche Conference Registration outside the submitted work. Dr Harbeck reported receiving personal fees from AstraZeneca, Daiichi Sankyo, Lilly, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, and SeaGen outside the submitted work. Dr Fox reported receiving personal fees from Novartis and Sierra Oncology outside the submitted work. Dr Fotia reported receiving personal fees from Novartis and Gentili outside the submitted work. Dr Parisi reported receiving personal fees from GlaxoSmithKline and Pharmamar outside the submitted work. Dr Queirolo reported serving as a consultant/advisory board member for MSD Pharma, Novartis, Bristol Myers Squibb, Roche, Sun Pharma, Sanofi, and Pierre Fabre. Dr Felip reported receiving grants from Pfizer not related to this project. Dr Newsom-Davis reported receiving personal fees from Amgen AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Guardant, Janssen & Janssen, Lilly, Merck, MSD Pharma, Novartis, Pfizer, Roche, Sanofi, and Takeda outside the submitted work. Dr Roldán reported receiving personal fees from MSD Pharma and travel expenses from Janssen and Novartis outside the submitted work. Dr Gennari reported serving a consulting/advisory role for Roche, MSD Pharma, Eli Lilly, Pierre Fabre, Eisai, and Daichii Sankyo; being a member of the speakers bureau for Eisai, Novartis, Eli Lilly, Roche, Teva, Gentili, Pfizer, AstraZeneca, Celgene, and Daichii Sankyo; and receiving research funds from Eisai, Eli Lilly, and Roche. Dr Martinez-Vila reported receiving travel grants and other honoraria from Bristol Myers Squibb, MSD Pharma, Novartis, and Roche. Dr Gaidano reported serving a consulting/advisory role for Janssen, AbbVie, AstraZeneca, and BeiGene; and receiving speaker fees from Janssen and AbbVie. Dr Sureda reported receiving personal fees from Takeda, Bristol Myers Squibb, MSD Pharma, Roche, GenMab, Novartis, Gilead Kite, and Janssen outside the submitted work. Dr Berardi reported receiving grants from AstraZeneca, Boehringer Ingelheim, Novartis, MSD Pharma, Otsuka, Lilly, Roche, Amgen, GlaxoSmithKline, and Eisai outside the submitted work. Dr Rimassa reported receiving consulting fees from Amgen, ArQule, AstraZeneca, Basilea, Bayer, Bristol Myers Squibb, Celgene, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, IQVIA, Lilly, MSD Pharma, Nerviano Medical Sciences, Roche, Sanofi, and Zymeworks; lecture fees from AbbVie, Amgen, Bayer, Eisai, Gilead, Incyte, Ipsen, Lilly, Merck Serono, Roche, and Sanofi; travel expenses from Ipsen; and institutional research funding from Agios, ARMO BioSciences, AstraZeneca, BeiGene, Eisai, Exelixis, Fibrogen, Incyte, Ipsen, Lilly, MSD Pharma, Nerviano Medical Sciences, Roche, and Zymeworks. Dr Tabernero reported having personal financial interest in the form of a scientific consultancy role for Array Biopharma, AstraZeneca, Avvinity, Bayer, Boehringer Ingelheim, Chugai, Daiichi Sankyo, F. Hoffmann-La Roche Ltd, Genentech Inc, HalioDX SAS, Hutchison MediPharma International, Ikena Oncology, IQVIA, Lilly, Menarini, Merck Serono, Merus, MSD Pharma, Mirati, Neophore, Novartis, Orion Biotechnology, Peptomyc, Pfizer, Pierre Fabre, Samsung Bioepis, Sanofi, Seattle Genetics, Servier, Taiho, Tessa Therapeutics, and TheraMyc; and educational collaboration with Imedex, Medscape Education, MJH Life Sciences, PeerView Institute for Medical Education, and Physicians Education Resource. Dr Tabernero also reported having an institutional financial interest in the form of financial support for clinical trials or contracted research for Amgen Inc, Array Biopharma Inc, AstraZeneca Pharmaceuticals LP, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Debiopharm International SA, F. Hoffmann-La Roche Ltd, Genentech Inc, HalioDX SAS, Hutchison MediPharma International, Janssen-Cilag SA, MedImmune, Menarini, Merck Health KGAA, MSD, Merus NV, Mirati, Novartis Farmacéutica SA, Pfizer, Pharma Mar, Sanofi Aventis Recherche & Développement, Servier, Taiho Pharma USA Inc, Spanish Association Against Cancer Scientific Foundation, and Cancer Research UK. Dr Cortellini reported receiving consulting fees from MSD, Bristol Myers Squibb, AstraZeneca, and Roche; and speakers’ fees from AstraZeneca, MSD Pharma, Novartis, and Astellas. No other disclosures were reported.

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