Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium.

Background: Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.

Methods: In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models.

Findings: 5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22-120), and median age was 72 years (IQR 66-79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20-8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54-13·5) than standard-risk patients.

Interpretation: The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.

Funding: US National Institutes of Health National Cancer Institute Cancer Center.

Competing Interests: The following authors declare competing interests not related to the current work: ZB reports grants from Genentech/imCORE, non-financial support from Bristol Myers Squibb, and personal fees from UpToDate. AE reports salary support from the Canadian Institute of Health Research, the Detweiler Travelling Fellowship (Royal College of Physicians and Surgeons of Canada), and the Henry R Shibata Fellowship (Cedar's Cancer Foundation). CRF reports grants from Merck Foundation, NCCN/Pfizer, and National Cancer Institute, and other support from National Cancer Institute and the Patient-Centered Outcomes Research Institute. PGri reports personal fees and non-financial support from AstraZeneca, personal fees from Astellas Pharma, personal fees from Bayer, grants and personal fees from Bristol Myers Squibb, grants and non-financial support from Clovis Oncology, personal fees from Dyania Health, grants and personal fees from EMD Serono, personal fees from Exelixis, personal fees from Foundation Medicine, personal fees from Genentech/Roche, personal fees from Genzyme, grants and personal fees from GlaxoSmithKline, personal fees from Guardant Health, grants and personal fees from Immunomedics/Gilead, personal fees from Infinity Pharmaceuticals, personal fees from Janssen, grants and personal fees from Merck, grants and personal fees from Mirati Therapeutics, grants and personal fees from Pfizer, grants and personal fees from QED Therapeutics, personal fees from Regeneron Pharmaceuticals, personal fees from Seattle Genetics, personal fees from 4D Pharma, personal fees from UroGen, grants from Bavarian Nordic, and grants from Debiopharm. SGup reports grants and personal fees from Bristol Myers Squibb, personal fees from Merck, Janssen, Seattle Genetis, EMD Sorono, and Pfizer, and grants from Astellas and BMS. CHw reports grants from Merck, Bayer, and AstraZeneca, and personal fees from Tempus and EMD Sorono, and other support from Johnson and Johnson. AK reports other support from TESARO, Fibrogen, Geistlich Pharma, Astellas Pharma, Rafael Pharmaceuticals, and Novocure. ARK reports other support from Merck and Sanofi, personal fees from OncLive, grants from ASCO Conquer Cancer Foundation, and grants from Bladder Cancer Advocacy Network. HK reports position on advisory board of Sanofi Genzyme NSCLC Northeast. NMK reports personal fees from BMS, Janssen, Seattle Genetics, Celldex, Sandoz, Invitae, Beyond Spring, Spectrum G1 Therapeutics, and Total Health, and grants from Amgen, Jazz Therapeutics, G1 Therapeutics, and Samsung. CL reports grants from imCORE/Genentech. RRM reports serving on advisory board or as a consultant for Astrazeneca, Aveo, Bayer, BMS, Caris, Dendreon, Exelixis, Janssen, Merck, Myovant, Novartis, Pfizer, Sanofi, Sorrento Therapeutics, and Tempus. RRM received institutional research funding from Pfizer, Bayer, Tempus. SM reports personal fees from National Geographic. OAP reports grants from National Institutes of Health (NIH) and Agency for Healthcare Research and Quality, and personal fees from International Consulting Associates. NAP reports personal fees from AstraZeneca, Merck, Pfizer, Eli Lilly, Genentech, BMS, Amgen, Inivata, G1 Therapeutics, Xencor, Mirati, Janssen, Boehringer Ingelheim, and Sanofi-Genzyme-Regeneron. RPR reports grants from BMS and Janssen, and personal fees from BMS, Janssen, Dova, and Inari. MAT reports personal fees from VIA Oncology, GSK, and Adaptive Advisory Board, other support from Syapse, UpToDate, Takeda, Celgene, Doximity, AbbVie, BMS, CRAB CTC, Denovo, Hoosier Research Network, Lilly, LynxBio, Strata Oncology, and TG Therapeutics. JLW reports personal fees from Roche, Westat, Flatiron Health, Melax Tech, and IBM Watson Health, other support from HemOnc and Janssen, and grants from AACR. TMW reports personal fees from Carevive, and personal fees from Sanofi, and Seattle Genetics. TMW-D reports grants from BMS, Merck, Janssen, and GSK/Tesaro, personal fees from Exicure, Shattuck Labs, Merck, Caris Life Science, and SITC, and other support from High Enroll. EW-B reports grants from Pfizer Global Medical Grants, personal fees from Astellas, Aveo Oncology Bristol Myers Squibb, Exelixis, and Janssen, and other support from Immunomedics and Nektar. The following authors declare competing interests during the conduct of the study: SM reports grants and other support from National Cancer Institute and from the International Association for the Study of Lung Cancer. DPS reports grants from American Cancer Society and Hope Foundation for Cancer Research and from NIH. LT reports grants from NIH. JLW reports grants from NIH. All other authors declare no competing interests.

(© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.)