Multinational consortium reports COVID-19 impact on cancer patients

COVID-19 affects everyone in some way, but it seems to affect cancer patients in particular, which is why Hollings Cancer Center researchers at the Medical University of South Carolina have joined a national and international consortium to explore the effects of the coronavirus disease on cancer patients.

Current evidence on COVID-19 and cancer found through the consortium’s research shows that patients with cancer showed a higher risk of SARS-CoV-2 infection compared with the general population. Data released yesterday in The Lancet and simultaneously presented at ASCO20 Virtual revealed cancer-specific factors associated with increased mortality.

The death rate for cancer patients as a whole was 13%, more than twice that reported for all patients with COVID-19 by the Johns Hopkins Center for Systems Science and Engineering. Certain subgroups, such as patients with active (measurable) cancer and those with an impaired performance status, fared much worse, said Jeremy Warner, M.D., an associate professor of Medicine and Biomedical Informatics at Vanderbilt University and the study’s corresponding author.

The information is the first report from this ongoing international initiative by the COVID-19 and Cancer Consortium (CCC19) to track outcomes within this vulnerable population. The CCC19 registry was built and is maintained as an electronic REDCap database housed at Vanderbilt University Medical Center.

The consortium currently is the largest registry of its kind with a global reach and has more than 100 participating institutions.

At Hollings, oncologists Antonio Giordano, M.D., Ph.D., and Daniel Reuben, M.D., and colleagues Sara Matar, M.D., and Sarah Mushtaq, M.D., will be gathering data as part of this registry to inform clinical practice in real time. Giordano said he’s glad Hollings Cancer Center can advance this important research initiative that will benefit the clinical management of cancer patients locally and worldwide.

Other findings in the recent Lancet report include:

• Fit patients with cancer and few comorbidities can and should proceed with appropriate anti-cancer treatment, whereas those with poor performance status or progressing cancer need to have thoughtful conversations with their oncology providers about the risks versus the benefits of anti-cancer treatment.
• Early data showed no statistical association between 30-day mortality and cancer treatments, suggesting that surgery, adjuvant chemotherapy and maintenance chemotherapy could continue during the pandemic with “extreme caution.”
• Mortality risk increased with the number of comorbidities, such as hypertension or diabetes, particularly in patients with two or more comorbidities. As is the case with the non-cancer population, mortality increased with age. Mortality was 6% for cancer patients younger than 65, 11% for those 65 to 74 and 25% for those older than 75. Males also had a higher death rate than females, 17% compared with 9%.

What has surprised Giordano about the study is the power of social media, including Twitter, Zoom and Slack. “It’s been amazing how fast it has come together. The study was put together in such a rapid manner thanks to a series of platforms, some of which may not have even been available 10 years ago.”

In this Q&A, Giordano explains how the registry works.

1) What are your main duties as Hollings’ principal investigator of this multi-institutional collaboration?

My role as a principal investigator is to identify the cancer patients infected with the novel coronavirus SARS-CoV-2 at our institution and to fill out their information in the survey forms for the COVID-19 and Cancer Consortium (CCC19) Registry. Drs. Sara Matar and Sarah Mushtaq, third- and first-year fellows in Hematology & Oncology, respectively, are co-investigators for this trial.

This is an international consortium with more than 100 participating institutions, and we are happy to have Hollings Cancer Center as one of the earliest collaborators to the consortium. As a principal investigator, I am actively involved in the weekly/biweekly meetings that the consortium holds where we discuss updates and future directions and suggest methods to use the data collected to serve our cancer patients better during the COVID-19 pandemic, especially those infected with the SARS-CoV-2 virus.

2) How are researchers collecting and disseminating information about the cancer patients who have been infected with COVID-19?

It is through collaborations like this consortium that we can better understand how this novel coronavirus SARS-CoV-2 affects our cancer patients. Each of the participating institutions is providing its data about cancer patients infected with COVID-19 through this consortium. Here at MUSC, we are keeping track of all the patients known to have cancer who have a confirmed diagnosis of SARS-CoV-2 infection and following their clinical courses closely. The information is disseminated to the CCC19 consortium through a HIPAA-compliant survey link that the investigators access to input the data.

Once the data from different institutions is collected and analyzed, it will be published to the public. Data from the first 1,000 patients were just analyzed, and we were excited to see the results that were just published in The Lancet and presented at the ASCO meeting. A list of the publications can be found on the consortium's website.

3) What are the data showing so far?

It was shown in the recent Lancet publication and studies from China that patients with a history of cancer seem to have a higher incidence of COVID-19 infection than the general population. Cancer patients also seem to be at higher risk of severe events from COVID-19 than the general population. We are hoping that the data collected through the CCC19 consortium will help us to understand more fully the impact of this new and dynamic virus on our vulnerable population and help to optimize the way we care for our cancer patients in the setting of this pandemic. The analysis will be published and available to the public as it comes out, and this might be in different phases and through different papers. There are several papers published so far, and we are looking forward to more in the future.

We know more data collection is needed. COVID-19 affects areas differently, and its severity differs  geographically. There is a huge need for increased surveillance and testing for SARS-CoV-2, minimizing health care system exposure and reconsideration of procedures and treatments in patients with cancer. In regions with high COVID prevalence, health care systems should screen asymptomatic individuals before cancer treatments.

4) Why do you feel it is important for Hollings Cancer Center researchers to be included in a registry such as this one?

I believe it is important to place Hollings Cancer Center on the map of the top cancer centers involved in the most recent research activities that help to advance research and the clinical management of cancer patients worldwide. There is still so much to be learned about this new and dynamic virus and its impact on our vulnerable patients. Being part of this consortium helps us to stay up to date with the most recent analysis and results that will help us to optimize our management of cancer patients infected with SARS-CoV-2 virus here at Hollings Cancer Center. This will help us to continue our mission to provide the best and most novel treatments for our patients based on cutting-edge research and evidence-based medicine.

5) How long is this trial planned to run?

This trial is planned to run for a year, but it might continue as long as more data is needed to answer questions addressed by this trial. Researchers are really worried about a second wave, which in some cases may bring a worse outcome than the first wave.

6) Is there anything else you would like for others to know about the COVID-19 and Cancer Consortium?

I would encourage everyone to check the updates from the CCC19, as it will affect how we treat cancer patients during this pandemic. I also encourage cancer patients with COVID-19 to be part of this trial, as this will help research progress and provide knowledge about this novel virus that will help us to treat current and future cancer patients more effectively. Each provider at MUSC can reach out to the investigators of this trial to report cancer patients diagnosed with SARS-CoV-2.

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