Clinical and Virologic Characteristics and Outcomes of Coronavirus Disease 2019 at a Cancer Center

Yoke, Leah H; Lee, Juhye M; Krantz, Elizabeth M; Morris, Jessica; Marquis, Sara; Bhattacharyya, Pooja; So, Lisa; Riedo, Francis X; Simmons, Jason; Khaki, Ali Raza; Cheng, Guang-Shing; Greninger, Alexander L; Pergam, Steven A; Waghmare, Alpana; Ogimi, Chikara; Liu, Catherine

BACKGROUND: High morbidity and mortality have been observed in cancer patients with COVID-19 infection; however, there are limited data on antimicrobial use, co-infections, and viral shedding. METHODS: We conducted a retrospective cohort study of adult patients at the Seattle Cancer Care Alliance diagnosed with COVID-19 infection between 2/28/2020 and 6/15/2020 to characterize antimicrobial use, coinfections, viral shedding and outcomes within 30 days after diagnosis. Cycle threshold values were used as a proxy for viral load. We determined viral clearance, defined as two consecutive negative PCR results using SARS-CoV-2 RT-PCR results through 7/30/2020. RESULTS: Seventy-one patients were included with a median age of 61 years; 59% had a solid tumor. Only 3 patients had documented respiratory bacterial co-infection. Empiric antibiotics for pneumonia were prescribed more frequently early in the study period (2/29/20-3/28/20;12/34) compared to the later period (3/29/20-6/15/20; 2/36) (P = .002). The median number of days from symptom onset to viral clearance was 37 days with viral load rapidly declining in the first 7-10 days after symptom onset. Within 30 days of diagnosis, 29 (41%) patients were hospitalized and 12 (17%) died. Each additional comorbidity was associated with 45% lower odds of days alive and out of hospital in the month following diagnosis in adjusted models. CONCLUSIONS: Patients at a cancer center, particularly those with multiple comorbidities, are at increased risk of poor outcomes from COVID-19 disease. Prolonged viral shedding is frequently observed among cancer patients and its implications on transmission and treatment strategies warrant further study.