Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19

Glenn J. Hanna; Eleni M. Rettig; Jong C. Park; Mark A. Varvares; Jochen H. Lorch; Danielle N. Margalit; Jonathan D. Schoenfeld; Roy B. Tishler; Laura A. Goguen; Donald J. Annino; Robert I. Haddad; Ravindra Uppaluri

doi:10.1016/j.oraloncology.2020.105087

Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19

Glenn J. Hanna^*, Eleni M. Rettig, Jong C. Park, Mark A. Varvares, Jochen H. Lorch, Danielle N. Margalit, Jonathan D. Schoenfeld, Roy B. Tishler, Laura A. Goguen, Donald J. Annino, Robert I. Haddad, Ravindra Uppaluri

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. Methods: This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Results: Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38–91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4–33.6) among all patients, and 71.5% (95%CI: 38.2–92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. Conclusions: We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.

Original language	English (US)
Article number	105087
Journal	Oral Oncology
Volume	112
DOIs	https://doi.org/10.1016/j.oraloncology.2020.105087
State	Published - Jan 2021

Funding

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘ G.J.H. is funded by the American Society of Clinical Oncology, Conquer Cancer Foundation, V Foundation, and Gateway for Cancer Research. He receives institutional support from BMS, Exicure, GSK, NantKwest/Altor BioScience, Kite, Regeneron, Kartos, Sanofi/Genzyme. Consulting and honoraria from BMS, Maverick, Merck, Kura, Sanofi/Genzyme, Bio- Rads, Prelude, and Bicara. J.H.L. receives research support from Novartis, Bayer, BMS and Takeda; consulting and honoraria: Bayer, Genentech. J.D.S. receives research support from ACCRF, Merck, BMS, and Regeneron; consulting and advisory board: Debiopharm, BMS, ACI Clinical, Tilos, LEK, Catenion, Nanobiotix, and AZ. SAB/equity from Immunitas and expert witness fees. R.I.H. receives research support from Pfizer, Genentech, Merck, BMS, Kura, AZ, and GSK; consulting for Merck, GSK, BMS, Genentech, Bayer, Pfizer, Immunomic, Nanobiotix, ISA, Glenmark, AZ. R.B.T. is on the data safety monitoring board for PSI/Oragenics, advisory board for Regeneron. The remaining authors have no relevant disclosures or conflicts of interest.’.

Keywords

COVID-19
Head and neck cancer
Hospitalization
Mortality
Symptoms

ASJC Scopus subject areas

Oral Surgery
Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.oraloncology.2020.105087

Cite this

Hanna, G. J., Rettig, E. M., Park, J. C., Varvares, M. A., Lorch, J. H., Margalit, D. N., Schoenfeld, J. D., Tishler, R. B., Goguen, L. A., Annino, D. J., Haddad, R. I., & Uppaluri, R. (2021). Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19. Oral Oncology, 112, Article 105087. https://doi.org/10.1016/j.oraloncology.2020.105087

@article{b3597edfb1ed414cbe3bb6fc91387066,

title = "Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19",

abstract = "Background: The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. Methods: This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Results: Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38–91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4–33.6) among all patients, and 71.5% (95%CI: 38.2–92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. Conclusions: We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.",

keywords = "COVID-19, Head and neck cancer, Hospitalization, Mortality, Symptoms",

author = "Hanna, {Glenn J.} and Rettig, {Eleni M.} and Park, {Jong C.} and Varvares, {Mark A.} and Lorch, {Jochen H.} and Margalit, {Danielle N.} and Schoenfeld, {Jonathan D.} and Tishler, {Roy B.} and Goguen, {Laura A.} and Annino, {Donald J.} and Haddad, {Robert I.} and Ravindra Uppaluri",

note = "Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: {\textquoteleft} G.J.H. is funded by the American Society of Clinical Oncology, Conquer Cancer Foundation, V Foundation, and Gateway for Cancer Research. He receives institutional support from BMS, Exicure, GSK, NantKwest/Altor BioScience, Kite, Regeneron, Kartos, Sanofi/Genzyme. Consulting and honoraria from BMS, Maverick, Merck, Kura, Sanofi/Genzyme, Bio- Rads, Prelude, and Bicara. J.H.L. receives research support from Novartis, Bayer, BMS and Takeda; consulting and honoraria: Bayer, Genentech. J.D.S. receives research support from ACCRF, Merck, BMS, and Regeneron; consulting and advisory board: Debiopharm, BMS, ACI Clinical, Tilos, LEK, Catenion, Nanobiotix, and AZ. SAB/equity from Immunitas and expert witness fees. R.I.H. receives research support from Pfizer, Genentech, Merck, BMS, Kura, AZ, and GSK; consulting for Merck, GSK, BMS, Genentech, Bayer, Pfizer, Immunomic, Nanobiotix, ISA, Glenmark, AZ. R.B.T. is on the data safety monitoring board for PSI/Oragenics, advisory board for Regeneron. The remaining authors have no relevant disclosures or conflicts of interest.{\textquoteright}. Publisher Copyright: {\textcopyright} 2020 Elsevier Ltd",

year = "2021",

month = jan,

doi = "10.1016/j.oraloncology.2020.105087",

language = "English (US)",

volume = "112",

journal = "Oral Oncology",

issn = "1368-8375",

publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19

AU - Hanna, Glenn J.

AU - Rettig, Eleni M.

AU - Park, Jong C.

AU - Varvares, Mark A.

AU - Lorch, Jochen H.

AU - Margalit, Danielle N.

AU - Schoenfeld, Jonathan D.

AU - Tishler, Roy B.

AU - Goguen, Laura A.

AU - Annino, Donald J.

AU - Haddad, Robert I.

AU - Uppaluri, Ravindra

N1 - Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘ G.J.H. is funded by the American Society of Clinical Oncology, Conquer Cancer Foundation, V Foundation, and Gateway for Cancer Research. He receives institutional support from BMS, Exicure, GSK, NantKwest/Altor BioScience, Kite, Regeneron, Kartos, Sanofi/Genzyme. Consulting and honoraria from BMS, Maverick, Merck, Kura, Sanofi/Genzyme, Bio- Rads, Prelude, and Bicara. J.H.L. receives research support from Novartis, Bayer, BMS and Takeda; consulting and honoraria: Bayer, Genentech. J.D.S. receives research support from ACCRF, Merck, BMS, and Regeneron; consulting and advisory board: Debiopharm, BMS, ACI Clinical, Tilos, LEK, Catenion, Nanobiotix, and AZ. SAB/equity from Immunitas and expert witness fees. R.I.H. receives research support from Pfizer, Genentech, Merck, BMS, Kura, AZ, and GSK; consulting for Merck, GSK, BMS, Genentech, Bayer, Pfizer, Immunomic, Nanobiotix, ISA, Glenmark, AZ. R.B.T. is on the data safety monitoring board for PSI/Oragenics, advisory board for Regeneron. The remaining authors have no relevant disclosures or conflicts of interest.’. Publisher Copyright: © 2020 Elsevier Ltd

PY - 2021/1

Y1 - 2021/1

N2 - Background: The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. Methods: This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Results: Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38–91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4–33.6) among all patients, and 71.5% (95%CI: 38.2–92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. Conclusions: We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.

AB - Background: The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. Methods: This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Results: Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38–91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4–33.6) among all patients, and 71.5% (95%CI: 38.2–92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. Conclusions: We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.

KW - COVID-19

KW - Head and neck cancer

KW - Hospitalization

KW - Mortality

KW - Symptoms

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DO - 10.1016/j.oraloncology.2020.105087

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VL - 112

JO - Oral Oncology

JF - Oral Oncology

M1 - 105087

ER -

Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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