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. 2023 Aug:34:101709.
doi: 10.1016/j.tranon.2023.101709. Epub 2023 Jun 2.

COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease

Melissa Y Y Moey  1 , Cassandra Hennessy  2 , Benjamin French  2 , Jeremy L Warner  3 , Matthew D Tucker  4 , Daniel J Hausrath  4 , Dimpy P Shah  5 , Jeanne M DeCara  6 , Ziad Bakouny  7 , Chris Labaki  7 , Toni K Choueiri  7 , Susan Dent  8 , Nausheen Akhter  9 , Roohi Ismail-Khan  10 , Lisa Tachiki  11 , David Slosky  12 , Tamar S Polonsky  13 , Joy A Awosika  14 , Audrey Crago  14 , Trisha Wise-Draper  14 , Nino Balanchivadze  15 , Clara Hwang  15 , Leslie A Fecher  16 , Cyndi Gonzalez Gomez  16 , Brandon Hayes-Lattin  17 , Michael J Glover  18 , Sumit A Shah  18 , Dharmesh Gopalakrishnan  19 , Elizabeth A Griffiths  19 , Daniel H Kwon  20 , Vadim S Koshkin  20 , Sana Mahmood  21 , Babar Bashir  21 , Taylor Nonato  22 , Pedram Razavi  22 , Rana R McKay  22 , Gayathri Nagaraj  23 , Eric Oligino  24 , Matthew Puc  25 , Polina Tregubenko  26 , Elizabeth M Wulff-Burchfield  26 , Zhuoer Xie  27 , Thorvardur R Halfdanarson  27 , Dimitrios Farmakiotis  28 , Elizabeth J Klein  28 , Elizabeth V Robilotti  29 , Gregory J Riely  29 , Jean-Bernard Durand  30 , Salim S Hayek  31 , Lavanya Kondapalli  32 , Stephanie Berg  33 , Timothy E O'Connor  33 , Mehmet A Bilen  34 , Cecilia Castellano  34 , Melissa K Accordino  35 , Blau Sibel  36 , Lisa B Weissmann  37 , Chinmay Jani  37 , Daniel B Flora  38 , Lawrence Rudski  39 , Miriam Santos Dutra  39 , Bouganim Nathaniel  40 , Erika Ruíz-García  41 , Diana Vilar-Compte  41 , Shilpa Gupta  42 , Alicia Morgans  43 , Anju Nohria  44 ; COVID-19 and Cancer Consortium
Affiliations

COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease

Melissa Y Y Moey et al. Transl Oncol. 2023 Aug.

Abstract

Background: Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited.

Objectives: To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF.

Methods: Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated.

Results: Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001).

Conclusions: Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).

Keywords: COVID-19 outcomes; Cancer; Cardio-oncology; Cardiovascular disease.

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Conflict of interest statement

R.M reports research funding from Bayer, Pfizer, and Tempus; and 18 personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Calithera, 19 Caris, Dendreon, Exelixis, Janssen, Johnson and Johnson, Merck & Co, Myovant, Novartis, Pfizer, Sanofi, Sorrento Therapeutics, Tempus, and Vividion. A.N. reports consulting fees from AstraZeneca, Takeda Oncology and Bantam Pharmaceuticals. B.B. reports research support to institution from Amgen, Bicycle Therapeutics, Boehringer Ingelheim, Ikena Oncology, Kahr Medical, Merck, Syros, Tarveda Therapeutics. Z.B. receives research support from 10.13039/100004328Genentech/imCORE and Bristol Myers Squibb. Personal fees from UpToDate. L.A.F reports clinical trial funding from BMS, EMDserono, Pfizer, Merck, Array, Kartos, Incyte, personal fees from Elsevier, ViaOncology, outside the submitted work. J.L.W. reports research funding from NIH/NCI during the conduct of the work, research funding from AACR, consulting fees from Westat, Roche, Flatiron Health, Melax Tech, other from HemOnc.org LLC (ownership), outside the submitted work. C.H reports stock holdings in Johnson and Johnson; research funding to institution from Merck, Bausch Health, Genentech, Bayer, and AstraZeneca, consultant fees from Tempus, Genzyme, and EMD Sorono, speaking fees from OncLive/MJH Life Sciences, travel fees from Merck, all outside the submitted work. The remaining authors have nothing to disclose.

Figures

Fig 1
Fig. 1
Flow Diagram. This diagram depicts details of the patients that were included and excluded in this analysis. CV = cardiovascular, CVD = cardiovascular disease, CVRF = cardiovascular risk factors.
Fig 2
Fig. 2
Risk of the Primary Ordinal Outcome was Significantly Increased in Patients with Cancer and Comorbid Cardiovascular Disease (CVD)/Cardiovascular Risk Factors. The primary outcome was an ordinal scale of progressive COVID-19 related adverse events starting with ambulatory, hospitalized, hospitalized with supplemental oxygen, need for intensive care unit (ICU), need for mechanical ventilation (MV), ICU or MV with inotropes/vasopressors, and death. Adjusted odds ratios (OR) with 95% confidence intervals (CI) are shown.
See this image and copyright information in PMC

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