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. 2023 Mar;98(3):451-457.
doi: 10.1016/j.mayocp.2022.12.008. Epub 2022 Dec 28.

Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19

Dereddi Raja Reddy  1 , John A Cuenca  2 , Joshua Botdorf  1 , Mayoora Muthu  3 , Ankit Hanmandlu  4 , Robert Wegner  1 , John Crommett  1 , Cristina Gutierrez  1 , Nisha Rathi  1 , Bilja Sajith  5 , Mark Knafl  6 , Hussein A Abbas  7 , Scott E Woodman  8 , Joseph L Nates  9 ; D3CODE Team Collaborators
Collaborators, Affiliations

Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19

Dereddi Raja Reddy et al. Mayo Clin Proc. 2023 Mar.

Abstract

There is scant information on the clinical progression, end-of-life decisions, and cause of death of patients with cancer diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death, 3 board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion among the 3 reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were nonsurvivors. Among nonsurvivors, 31 (51%) patients had hematologic cancers, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% confidence interval [CI], 11.8 to 18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission; however, 53 (87%) had do-not-resuscitate orders at the time of death. Most deaths were deemed to be COVID-19 related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents die because of their comorbidities, in our study only 1 of every 10 patients died of cancer-related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with nonresuscitative measures rather than full support at the end of life.

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Conflict of interest statement

The authors report no competing interests.

Drs Reddy, Cuenca, Botdorf, Wegner, and Nates had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Drs Reddy, Cuenca, Botdorf, Wegner, Gutierrez, and Nates were responsible for the concept and design of this article. Drs Reddy, Cuenca, Botdorf, Wegner, Crommett, Gutierrez, Rathi, Abbas, and Nates were responsible for the acquisition, analysis, or interpretation of data.

Drs Reddy, Cuenca, and Hanmandlu drafted the manuscript. All authors were responsible for the critical revision of the manuscript for important intellectual content. Dr Cuenca was responsible for the statistical analysis. Drs Sajith, Knafl, Woodman, and Nates were in charge of administrative, technical, or material support. Drs Woodman, Abbas, and Nates supervised.

Figures

Figure 1
Figure 1
Study flowchart. Flowchart of patients admitted to the COVID-19 unit within the study period.
Figure 2
Figure 2
Time to death by subgroups. Kaplan-Meier curves displaying survival analysis by subgroups: A, Treatment intent; B, cancer type. C, COVID-19–related deaths by cancer type.
See this image and copyright information in PMC

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