COVID-19 Outcomes in Patients With Gynecologic Cancer

Patients with gynecologic cancer experience significant morbidity and mortality related to COVID-19, according to research presented at the 2022 ASCO Annual Meeting. 

Increasing age, Black race, active or progressing cancer, and certain comorbidities and COVID-19 complications were all associated with an increased risk of severe COVID-19 outcomes.

Researchers conducted this retrospective study to evaluate the severity of short-term COVID-19 outcomes in patients with gynecologic cancers and laboratory confirmed SARS-CoV-2 infection from the international CCC19 registry. 

The researchers defined severity of COVID-19 outcomes from least to most severe as hospitalization, intensive care unit (ICU) admittance, mechanical ventilation, and 30-day mortality.

A total of 842 patients were studied. Most patients (83%) were from the United States, and 46% were non-Hispanic White. The mean age was 61.4 years. Comorbidities included cardiac (23%), pulmonary (16%), and renal (12%). Four percent of patients were fully or partially vaccinated against SARS-CoV-2.

The patients had endometrial cancer (48%), ovarian cancer (24%), cervical cancer (22%), and dual primary/other gynecologic cancers (6%). Half of patients were in remission, 37% had active disease, and 22% had metastatic disease. 

In the 3 months prior to getting COVID-19, 36% of patients had received any cancer treatment. Treatments included chemotherapy (23%), targeted therapy (8%), and radiation (6%).

Most patients (76%) presented with typical COVID-19 symptoms, but 18% were asymptomatic. Severe COVID-19 complications occurred in 31% of patients. Complications included pneumonia/pneumonitis (24%), sepsis (12%), and venous thromboembolism (5%). Twelve percent of patients had a co-infection with 2 weeks of COVID-19 diagnosis. 

Half of patients were hospitalized for COVID-19, 12% were admitted to the ICU, 8% required mechanical ventilation, and 10% died within 30 days of testing positive for SARS-CoV-2. The all-cause mortality rate was 16%. 

In a multivariable analysis adjusted for age, race, and cancer status, factors that were significantly associated with an increased risk of severe COVID-19 outcomes included:

• A 1-year increase in age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04)
• Non-Hispanic Black race (OR, 2.04; 95%, 1.39-2.99) 
• Cardiac comorbidities (OR, 1.57; 95% CI, 1.13-2.19) 
• Renal comorbidities (OR, 2.00; 95% CI, 1.33-3.00) 
• ECOG performance status of 2 or higher (OR, 5.15; 95% CI, 3.21-8.27)
• Pneumonia or pneumonitis (OR, 4.08; 95% CI, 2.94-5.66)
• Venous thromboembolism (OR, 4.67; 95% CI, 2.49-8.75)
• Sepsis (OR, 14.2, 95% CI, 9.05-22.1)
• Any co-infection within 2 weeks of SARS-CoV-2 infection (OR, 4.40; 95% CI, 2.91-6.65).

Active or progressing cancer was associated with an increased risk of severe COVID-19 outcomes (OR, 2.05; 95% CI, 1.31-3.23). However, neither cancer site nor cancer treatment was associated with COVID-19 severity.

Asymptomatic COVID-19 was associated with decreased severity of COVID-19 outcomes (OR, 0.25; 95% CI, 0.16-0.38). 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Beeghly-Fadiel A, Prescott LS, Ruiz-Garcia E, et al. COVID-19 in patients with gynecologic cancer: A preliminary report from the COVID-19 and Cancer Consortium (CCC19). Presented at ASCO 2022; June 3-7, 2022. Abstract 5508.