How does COVID-19 affect cancer patients? The largest U.S. study shares the first results


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In the largest study of its kind to date, researchers analyzing national data from more than 63,000 cancer patients and a positive diagnosis of COVID-19 report an increased risk of death among those who were older. , men, had a higher number of comorbidities and had hematologic cancers and recent chemotherapy treatments.

These results were shared in an oral presentation on June 4 at the annual meeting of the American Society of Clinical Oncology by the University of Alabama at Birmingham, Assistant Professor Noha Sharafeldin, MBBCh, Ph.D. Sharafeldin is a physician and epidemiologist in the Hematology and Oncology Division and a member of the UAB Institute for Cancer Results and Survival and the O’Neal Comprehensive Cancer Center.

A more detailed journal article was published simultaneously in the society Journal of Clinical Oncology.

The results are one of the first major publications of the National COVID Cohort Collaborative, known as the N3C. The UAB and 54 other clinical institutions across the country have provided data from unidentified electronic health records of 6.2 million patients in 49 states to a secure cloud-based database to enable early research. The N3C began curing data in January 2020 and its database contains patient records dating back to 2018. Among the 6 billion rows of data collected are more than 2 million positive COVID diagnoses and more than 400,000 patients diagnosed with cancer.

“A ladder that was not possible before”

“People in the cancer world are eager to learn more about the effects of COVID-19 in general and its interaction with specific types of cancer and cancer treatments,” Sharafeldin said.

Previous studies in relatively small cohorts have found variations in the risk of cancer patients.

“The N3C contains a wealth of data that has allowed us to investigate these questions on a scale that until now was not possible, using real-world clinical data,” Sharafeldin said. “The strength of this first report is that it demonstrates the usefulness of resources like N3C and the collaborative research that has made it possible. There are other cohorts of cancer patients / COVID, but nothing the size of N3C or with the same level of patient representation across the country “.

Since its founding, N3C’s leadership has encouraged researchers interested in the effects of COVID-19 under certain health conditions to form clinical domain teams. Along with Umit Topaloglu, Ph.D., computer scientist at Wake Forest University, and Benjamin Bates, a physician at Rutgers University, Sharafeldin co-leads the N3C oncology domain team.

“We began by simply investigating the feasibility of answering these questions we had about the effects of COVID in cancer patients using N3C data resources,” Sharafeldin said. “As we progressed, the oncology domain team began to expand to include biostatisticians, bioinformatics and analysis experts and researchers in machine learning and other advanced applications, as well as clinicians, all under the umbrella of being interested in cancer “.

Question number 1: can it be done?

One of N3C’s strengths has been its data harmonization of a wide range of electronic medical record systems and hospital databases. Sharafeldin and the oncology domain team had to create their cancer cohort for the first time from the mass of data by defining terms and giving meaning to diagnostic codes and diagnostic deadlines.

“You could have a patient who had just been diagnosed or who had been diagnosed many years earlier and who was a survivor,” Sharafeldin said. “They could be in remission or receiving care at the end of life.”

There have been many challenges in handling real-world data that researchers needed to navigate, including identifying the patient’s primary site of cancer and defining cancer treatment categories.

“We have a lot of questions, but we thought the number 1 question to answer first was whether we could cure and describe a cancer cohort and examine the risk of mortality in our cohort,” Sharafeldin said. “Cancer patients are already a vulnerable population; we wanted to identify the factors that put these patients at risk.”

In its presentation and the accompanying manuscript, the oncology domain team shared conclusions about these risk factors.

Study results

Of the total of 398,579 adult cancer patients identified in the N3C cohort, 63,413 (15.9%) were diagnosed as COVID-positive. The most commonly represented cancers were skin cancer (13.8 percent), breast cancer (13.7 percent), prostate cancer (10.6 percent), hematologic (10.5 percent), and GI cancer. 10 percent). COVID-19 positivity was significantly associated with an increased risk of all-cause mortality. Among COVID-positive patients, several characteristics were associated with an increased risk of mortality from all causes:

  • 65 years or older
  • male gender
  • residents in the southern or western United States
  • adjusted Charlson comorbidity index score of 4 or higher
  • patients with hematologic malignancies
  • patients with multitumor sites
  • patients who received recent treatment with chemotherapy (within 30 days)

“Age, male gender, and growing comorbidities have been found to be important risk factors for the general population, and they also remained in our cohort,” Sharafeldin said.

Consistent with previous literature (including this one June 2020 paper The Lancet i this February 2021 document inside Annals of Oncology), patients with hematologic malignancies had higher mortality, while the N3C data set confirmed that “patients who received recent immunotherapies or targeted therapies did not have a higher risk of overall mortality,” wrote Sharafeldin and its co-authors Journal of Clinical Oncology manuscript.

In the future, researchers aim to delve deeper into the data to “provide more information about the effects of COVID-19, including the effects of vaccinations on cancer outcomes and the ability to continue specific cancer treatments,” they wrote.

“We want to delve deeper into patient records and take a more nuanced look at treatments,” Sharafeldin explained. “Future cohort studies will provide information on the evolutionary effect of COVID – 19 in patients with and guide clinical treatment “.

“People interested in all aspects”

Long-distance collaborations and the quick amount of time for work have been tiring at times, Sharafeldin says, but also invigorating.

“It’s been very collaborative, enjoyable and open,” he said, noting that the team includes everyone, from tenured professors to graduate students. “In general, you need to know someone, have connections and mentors and a healthy network to access that kind of data and be successful. With N3C, you just have to be willing to share your skills.”

Sharafeldin encourages other scientists, regardless of their experience, to do so visit the N3C website and interact with other people around their area of ​​interest. “There is a great diversity in N3C domain teams covering a wide range of clinical interests,” Sharafeldin said.

Recognition to ASCO and publication in a top-tier magazine are some of the most high-profile results of N3C to date, which have excited everyone involved in the project, according to Sharafeldin.

“So many people have volunteered their time and worked there,” Sharafeldin said. In addition to researchers and clinicians, there are specialists in data programming and analysis and database architecture of private companies and institutes.

“Within all domain teams, there is N3C logic and data links and experts on how the cohort is being created to help us navigate and provide ongoing support, as well as a knowledge warehouse where researchers they share workflows and technical support, ”he said. .

“The beauty of N3C is that it’s this really open environment, and if you’re willing to dedicate your time and experience, you can make a difference,” Sharafeldin said. “Throughout this pandemic, everyone has wanted to contribute and help. Once you have the opportunity to do so, it’s very exciting.”

People hospitalized with active cancer are more likely to die from COVID-19

More information:
Noha Sharafeldin et al, COVID-19 Outcomes in Cancer Patients: A Report from the COVID National Collaborative Cohort (N3C), Journal of Clinical Oncology (2021). DOI: 10.1200 / JCO.21.01074

Citation: How does COVID-19 affect cancer patients? The largest study in the United States shares the first results (2021, June 11), retrieved June 12, 2021 from largest.html

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