Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
Donna R. Rivera, Solange Peters, Orestis A. Panagiotou, Dimpy P. Shah, Nicole M. Kuderer, Chih–Yuan Hsu, Samuel M. Rubinstein, Brendan J. Lee, Toni K. Choueiri, Gilberto Lopes, Petros Grivas, Corrie Painter, Brian I. Rini, Michael A. Thompson, Jonathan Arcobello, Ziad Bakouny, Deborah B. Doroshow, Pamela Egan, Dimitrios Farmakiotis, Leslie A. Fecher, Christopher R. Friese, Matthew D. Galsky, Sanjay Goel, Shilpa Gupta, Þorvarður R. Hálfdánarson, Balázs Halmos, Jessica E. Hawley, Ali Raza Khaki, Christopher A. Lemmon, Sanjay Mishra, Adam J. Olszewski, Nathan A. Pennell, Matthew Puc, Sanjay G. Revankar, Lidia Schapira, Andrew Schmidt, Gary K. Schwartz, Sumit Shah, Julie Wu, Zhuoer Xie, Albert C. Yeh, Huili Zhu, Yu Shyr, Gary H. Lyman, Jeremy L. Warner
Abstract
Abstract Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. Significance: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access. This article is highlighted in the In This Issue feature, p. 1426