Clinical Characteristics, Care Trajectories and Mortality Rate of SARS CoV 2 Infected Cancer Patients Among 29307 Cancer Patients in AP HP Hospitals During the COVID 19 Pandemic. A Multicenter Cohort Study in Electronic Health Records

Background: It was suggested that Coronavirus disease 2019 (COVID-19) may affect more frequently and with more severe evolution cancer patients. Our objectives were to assess the COVID-19 rate in cancer patients, to characterize their demographic, clinical and biological features and to assess their care trajectories and case-fatality rate. Methods: Based of Electronic Health Records of the Assistance Publique - Hopitaux de Paris, cancer patients were identified according to previous or actual history of cancer, and among them all patients tested for SARS-CoV-2 between March 03, 2020, and May 19, 2020 were included in this retrospective cohort study. We assessed the COVID-19 rate, described the clinical and biological cancer-related and non-cancer characteristics, care trajectories and mortality rate. Main outcome was COVID-19 assessed by positivity of Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2. Findings: Among the 29307 cancer patients, 8104 (28%) underwent a SARS-CoV-2 RT-PCR test. A total of 1672 patients (21% among tested cancer patients, 99% CI: 19 - 22) had COVID-19. Among them, median age was 75 years, 57% were men, 21% had gastro-intestinal tumors, 21% hematological malignancies, 22% were metastatic; 52% had a recent cancer diagnosed in 2019 or early 2020. Regarding the comorbidities, 51% had hypertension, 32% coronary heart diseases or heart failure, 27% diabetes, and 24% cardiac arrhythmia. Overall, 86% were hospitalized, and among them 18% in Intensive Care-Unit. Mortality rate for this population was 26% (99% CI: 24-28). During the same period, among the 309474 non-cancer patients, 98134 were tested for COVID-19 (32%), 24% (99% CI: 24-24) had a confirmed COVID-19 diagnosis. Mortality rate was 8·6%. Interpretation: Our results suggest that in hospital-based setting, cancer patients were not more affected by COVID-19 than non-cancer patients and that the high case fatality-rate may be mainly driven by advanced age and comorbidities. Funding Statement: Supported by Assistance Publique -Hopitaux de Paris Foundation. Declaration of Interests: MAB, JL, DW, EK, GG, MB, NP, TM, AB, CD, JC, FCP and JG do not declare any relevant conflicts of interest in the context of this work. JG reports grants from Eisai, Genomic-Health, Pfizer, Roche-Genentech, personal fees from Daiichi, Eisai, Genomic-Health, Macrogenics, MSD, Novartis, Onxeo, Pfizer, Roche-Genentech and non-financial support from Eisai, Genomic-Health, Novartis, Pfizer, Roche-Genentech, outside the submitted work. Ethics Approval Statement: On April 16, 2020, the Scientific and Ethics Committee of the AP-HP Health Data Warehouse gave a positive opinion to our research project concerning the analysis of data from cancer patients diagnosed COVID-19 at AP-HP. This study was approved by Institutional Review Board (IRB 00011591). The database was authorized by the National Freedom and Informatic Commission (CNIL Number 1980120).