Survival of patients diagnosed with stage IV cancer in 2020 based on COVID-19 status.

Abstract

e24041 Background: The COVID-19 pandemic disrupted the evaluation and treatment of many cancer patients. Contracting a COVID-19 infection could further exacerbate care delays, as well as triggering immune modulations with the potential to alter tumor behavior. To better understand the implications of COVID-19 infection we evaluated cancer patient survival during the first year of the pandemic. Methods: Treated stage IV cancerpatients diagnosed in 2020, who were tested for COVID and were captured by the National Cancer Database were studied. Cox proportional hazards models controlled for age, sex, race/ethnicity, Charlson Deyo score, income, insurance, region, facility type, and treatment modality (radiation, surgery, chemotherapy, and immunotherapy). Unadjusted Kaplan Meier analysis was also performed. Results: Overall,54,042 patients were identified (6,027 breast, 7,226 colon, 2,997 esophageal, 1,950 liver, 25,051 Non- Small Cell Lung Cancer (NSCLC), and 10,791 pancreatic). Overall, 33,922 patients were documented to be tested for COVID-19 with 2,262 (6.7%) having tested positive (Table). Testing positive for Covid was actually associated with lower mortality risk for NSCLC HR 0.80 (0.74-0.87) P<0.001 and pancreatic cancer HR 0.79 (0.69-0.90) P<0.001 compared those testing negative. A similar trend was seen for other cancer types but was not significant. Conclusions: Testing positive for COVID 19 did not appear to compromise stage IV cancer patient survival in the first year of the pandemic, and the outcomes were similar to the previous year. Further study is warranted to understand the immunologic consequences of COVID 19 and tumor behavior. Risk adjusted 2 year mortality for COVID positive patients by cancer type. COVID (+) COVID (-) HR 95% CI P 2019 N tested N % N % N alive at 2 years % alive at 2 years Breast 3970 380 9.57 3590 90.43 0.83 0.69; 1.00 0.050 6500 65.82 Colon 4806 337 7.01 4469 92.99 0.86 0.73; 1.01 0.062 5041 45.37 Esophagus 2131 130 6.10 2001 93.90 0.87 0.71; 1,08 0.209 1180 26 Liver 962 57 5.93 905 94.07 0.79 0.57; 1.11 0.174 477 22 NSCLC 16349 1039 6.36 15310 93.64 0.80 0.74; 0.87 <.001 12571 32.99 Pancreas 5704 319 5.59 5385 94.41 0.79 0.69; 0.90 <.001 2497 20.21