Alaina J Brown, Chih-Yuan Hsu, Aleenah Mohsin, Lauren S Prescott, Alicia Beeghly, Erika Ruiz-Garcia, Diana Vilar-Compte, José Antonio García-Gordillo, Clara Hwang, Miriana Hijaz, Thomas Buekers, Sunny R K Singh, Trisha M Wise-Draper, Elizabeth K Ferrara, Rana R McKay, Archana Ajmera, Melissa Mariano, Padmanabh Bhatt, Gayathri Nagaraj, Matthew Puc, Jonathan A Cosin, Babar Bashir, Karen Russell, Susan Halabi, Hannah McManus, Melissa K Accordino, Blanche H Mavromatis, Monika Joshi, Hyma V Polimera, Salvatore A Del Prete, Suzanne J Rose, Suki Subbiah, Bryan A Faller, Abdul Hai Mansoor, Marc Eid, Sanjay Mishra, Roisin E O'Cearbhaill, Marta A Crispens, Yu Shyr, Jeremy L Warner
Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, comorbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes.
PURPOSE: Limited information exists regarding outcome severity among gynecologic cancer patients with SARS-CoV-2 infection. The objective of this study was to describe patient, cancer, and COVID-19 characteristics, and to identify factors associated with COVID-19 severity.
METHODS: Gynecologic cancer patients with SARS-CoV-2 infection were identified from the international COVID-19 and Cancer Consortium registry. We estimated odds ratios (ORs) for associations with severity of COVID-19 outcomes. Multivariable models included adjustment for age, race, cancer status, and time period of COVID-19 diagnosis.
RESULTS: Of 920 patients, 438 patients (48%) had endometrial, 249 (27%) had ovarian, 198 (22%) had cervical, and 44 (5%) had vulvar/vaginal cancers. Most were from the United States (86%) and non-Hispanic White (48%). Median age was 62 years (IQR, 52-71). When diagnosed with COVID-19, 457 (49%) patients were in remission and 343 (37%) had active disease. Outcomes included hospitalization in 452 patients (49%), intensive care unit admittance in 107 patients (12%), mechanical ventilation in 70 patients (8%), and death within 30 days of testing positive for SARS-CoV-2 in 91 patients (10%). In multivariable models, increasing age (adjusted OR, 1.35 [95% CI, 1.23 to 1.49]) and non-Hispanic Black race (adjusted OR, 1.75 [95% CI, 1.24 to 2.48]) were associated with increased COVID-19 severity, as were cardiac (adjusted OR, 1.85 [95% CI, 1.36 to 2.52]), pulmonary (adjusted OR, 1.58 [95% CI, 1.12 to 2.22]), and renal (adjusted OR, 2.18 [95% CI, 1.48 to 3.19]) comorbidities. Patients in remission <5 years had decreased COVID-19 severity (adjusted OR, 0.60 [95% CI, 0.42 to 0.87]). Other cancer characteristics associated with increased severity included progression (adjusted OR, 2.91 [95% CI, 1.92 to 4.40]), stage (adjusted OR, 1.57 [95% CI, 1.11 to 2.22]), and metastatic disease (adjusted OR, 1.60 [95% CI, 1.10 to 2.34]).
CONCLUSION: Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, comorbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes.