High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR

Assaad, Souad; Avrillon, Virginie; Fournier, Marie-Line; Mastroianni, Benedicte; Russias, Bruno; Swalduz, Aurélie; Cassier, Philippe; Eberst, Lauriane; Steineur, Marie-Pierre; Kazes, Marianne; Perol, Maurice; Michallet, Anne-Sophie; Rey, Philippe; Erena-Penet, Anne-Sophie; Morel, Astrid; Brahmi, Mehdi; Dufresne, Armelle; Tredan, Olivier; Chvetzoff, Gisèle; Fayette, Jérome; Fouchardiere, Christelle de la; Ray-Coquard, Isabelle; Bachelot, Thomas; Saintigny, Pierre; Tabutin, Mayeul; Dupré, Aurélien; Nicolas-Virelizier, Emmanuelle; Belhabri, Amine; Roux, Pierre-Eric; Fuhrmann, Christine; Pilleul, Franck; Basle, Alexandre; Bouhamama, Amine; Galvez, Christelle; Herr, Andrée-Laure; Gautier, Julien; Chabaud, Sylvie; Zrounba, Philippe; Perol, David; Blay, J.Y.

BACKGROUND: Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. METHODS: PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 RT-PCR positive and negative patients. RESULTS: 55 of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR+ patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of CTscan. However, respectively 38% and 20% of SARS-COV-2 RT-PCR negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after first symptoms, the death rate in RT-PCR+ and RT-PCR-patients were 21% and 10% respectively. In both groups, independent risk factors for death were male gender, KPS<60, cancer in relapse, and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p=0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2…) correlated with survival. The survival of RT-PCR positive and negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CTscan was similar with a 18.4% and 19.7% death-rate at day-25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. CONCLUSION: The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR negative patients.