Clinical outcomes of patients with cancer who tested positive for COVID-19 hospitalised in a UK district general hospital

Abstract

Background Individuals diagnosed with cancer have been particularly affected by the COVID-19 pandemic. Most of the relevant information so far has come from tertiary cancer centres and less is known of the outcomes of patients in District General Hospitals (DGH). In this audit, we aimed to investigate the clinical outcomes of patients with cancer who tested positive for COVID-19 and were admitted in a DGH. Methods Electronic records of patients admitted at Tameside General Hospital (TGH) (>500 beds) between March 2020�March 2021 were reviewed retrospectively. Clinical outcomes of those who tested positive for COVID-19 and factors relating to death were analysed. Cox regression and Kaplan-Meier survival analyses were performed (SPSS v26.0). Results Within the 12-month study period, there were 2417 inpatients who tested positive for COVID-19 at TGH. Of 235 individual patients with cancer admitted during this period, 14% (n=33) tested positive. Median age was 75 (68;81) years; majority female (67%). The most prevalent primary site of cancer were lung (21%) and breast (12%). Most were ECOG PS 1 (39%) or PS 2 (36%), and had high Charlson Comorbidity Index (median 5 (3;6), range 0-10). 24% of patients were on curative treatment, 39% palliative treatment, 18% best supportive care and 18% not on treatment. Types of treatment included chemotherapy (37%), hormonal treatment (26%), radiotherapy (21%) and immunotherapy (5%). On average, patients were admitted at least once (range 0-4) prior to positive test for COVID-19. At last follow-up, there were n=664/2417 (27%) and n=22/33 (67%) deaths in the non-cancer and cancer patient subgroups, respectively. The median time from diagnosis of COVID-19 to death/censor date was 44 (4;85) days. In univariate Cox regression analysis, only ECOG PS was significantly correlated with death, HR 1.523 (95% CI 1.064-2.181, p=0.022). Conclusions The outcomes of our cohort of patients with cancer who tested positive for COVID-19 and hospitalised were poor. The high comorbidity burden and poor ECOG PS could potentially account for this rather than the recent oncological treatment. Acute oncology input to general medical teams treating cancer patients with COVID-19 is pivotal for best possible outcomes for patients.