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

• Type of Material: Article
• Authors: Melissa YY Moey, East Carolina University; Cassandra Hennessy, Vanderbilt University; Benjamin French, Vanderbilt University; Jeremy L Warner, Vanderbilt University; Matthew D Tucker, Vanderbilt University; Daniel J Hausrath, Vanderbilt University; Dimpy P Shah, UTHlth San Antonio MD Anderson; Jeanne M DeCara, University of Chicago; Ziad Bakouny, Dana-Farber Cancer Institute, Boston; Chris Labaki, Dana-Farber Cancer Institute, Boston; Toni K Choueiri, Dana-Farber Cancer Institute, Boston; Susan Dent, Duke University; Nausheen Akhter, Northwestern University; Roohi Ismail-Khan, University of South Florida; Lisa Tachiki, University of Washington; David Slosky, Vanderbilt University; Tamar S Polonsky, University of Chicago; Joy A Awosika, University of Cincinnati; Audrey Crago, University of Cincinnati; Trisha Wise-Draper, University of Cincinnati; Nino Balanchivadze, Henry Ford Hospital; Clara Hwang, Henry Ford Hospital; Leslie A Fecher, University of Michigan; Cyndi Gonzalez Gomez, University of Michigan; Brandon Hayes-Lattin, Knight Cancer Institute at Oregon Health and Science University; Michael J Glover, Stanford University; Sumit A Shah, Stanford University; Dharmesh Gopalakrishnan, Roswell Park Comprehensive Cancer Center; Elizabeth A Griffiths, Roswell Park Comprehensive Cancer Center; Daniel H Kwon, University of California San Francisco; Vadim S Koshkin, University of California San Francisco; Sana Mahmood, Thomas Jefferson University; Babar Bashir, Thomas Jefferson University; Taylor Nonato, University of California San Diego; Pedram Razavi, University of California San Diego; Rana R McKay, University of California San Diego; Gayathri Nagaraj, Loma Linda University; Eric Oligino, Hartford HealthCare Cancer; Matthew Puc, Virtua Health, Marlton, NJ; Polina Tregubenko, The University of Kansas Health System, Kansas City; Elizabeth M Wulff-Burchfield, The University of Kansas Health System, Kansas City; Zhuoer Xie, Mayo Clinic, Rochester; Thorvardur R Halfdanarson, Mayo Clinic, Rochester; Dimitrios Farmakiotis, Brown University; Elizabeth J Klein, Brown University; Elizabeth V Robilotti, Mem Sloan Kettering Cancer Center; Gregory J Riely, Mem Sloan Kettering Cancer Center; Jean-Bernard Durand, MD Anderson Cancer Center; Salim S Hayek, University of Michigan; Lavanya Kondapalli, University of Colorado Anschutz Medical Campus; Stephanie Berg, Loyola University Medical Center; Timothy E O'Connor, Loyola University Medical Center; Mehmet Bilen, Emory University; Cecillia Castellano, Emory University; Melissa K Accordino, Columbia University; Blau Sibel, Northwest Medical Specialties; Lisa B Weissmann, Mount Auburn Hospital; Chinmay Jani, Mount Auburn Hospital; Daniel B Flora, St Elizabeth Healthcare; Lawrence Rudski, McGill University; Miriam Santos Dutra, McGill University; Bouganim Nathaniel, McGill University; Erika Ruiz-Garcia, Instituto Nacional de Cancerología; Diana Vilar-Compte, Instituto Nacional de Cancerología, Mexico City; Shilpa Gupta, Cleveland Clinic; Alicia Morgans, Dana Farber Cancer Institute; Anju Nohria, Dana Farber Cancer Institute
• Language: English
• Date: 2023-08-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.tranon.2023.101709
• Title of Journal or Parent Work: TRANSLATIONAL ONCOLOGY
• Volume: 34
• Start Page: 101709
• End Page: 101709
• Grant/Funding Information: This work was supported by National Cancer Institute (NCI) grant P30CA016056 involving the use of Roswell Park Comprehensive Cancer Center's Hematologic Procurement Shared Resource and grant P30 CA123456. This study was also supported by grants from the National Cancer Institute grant number P30 CA068485 to Vanderbilt University Medical Center. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS / NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication.
• Keywords: Cancer; Life Sciences & Biomedicine; Cardio-oncology; Oncology; Cardiovascular disease; COVID-19 outcomes; Science & Technology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Biology, Biostatistics

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).