COVID-19 outcomes of patients with gynecologic cancer in New York City: An updated analysis from the initial surge of the pandemic.

BACKGROUND: Despite significant increase in COVID-19 publications, characterization of COVID-19 infection in patients with gynecologic cancer remains limited. Here we present an update of COVID-19 outcomes among people with gynecologic cancer in New York City (NYC) during the initial surge of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]). METHODS: Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 NYC area hospital systems between March and June 2020. Multivariable logistic regression was utilized to estimate associations between factors and COVID-19 related hospitalization and mortality. RESULTS: Of 193 patients with gynecologic cancer and COVID-19, the median age at diagnosis was 65.0 years (interquartile range (IQR), 53.0-73.0 years). One hundred six of the 193 patients (54.9%) required hospitalization; among the hospitalized patients, 13 (12.3%) required invasive mechanical ventilation, 39 (36.8%) required ICU admission. Half of the cohort (49.2%) had not received anti-cancer treatment prior to COVID-19 diagnosis. No patients requiring mechanical ventilation survived. Thirty-four of 193 (17.6%) patients died of COVID-19 complications. In multivariable analysis, hospitalization was associated with an age ≥ 65 years (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.11, 4.07), Black race (OR 2.53, CI 1.24, 5.32), performance status ≥2 (OR 3.67, CI 1.25, 13.55) and ≥ 3 comorbidities (OR 2.00, CI 1.05, 3.84). Only former or current history of smoking (OR 2.75, CI 1.21, 6.22) was associated with death due to COVID-19 in multivariable analysis. Administration of cytotoxic chemotherapy within 90 days of COVID-19 diagnosis was not predictive of COVID-19 hospitalization (OR 0.83, CI 0.41, 1.68) or mortality (OR 1.56, CI 0.67, 3.53). CONCLUSIONS: The case fatality rate among patients with gynecologic malignancy with COVID-19 infection was 17.6%. Cancer-directed therapy was not associated with an increased risk of mortality related to COVID-19 infection.

Outcomes of gynecologic oncology patients at an epicenter of the COVID-19 pandemic

To describe the clinical course and associated mortality and morbidity of gynecologic cancer patients with COVID-19 infection with respect to cancer status, demographics, and comorbidities. An IRB approved prospective registry was initiated of all gynecologic oncology patients with COVID-19 infections at a health care system in New York City from March 1 to June 1 2020. Clinical and demographic data was abstracted from the electronic medical record. Univariate and multivariate regression analyses were performed to identify factors associated with development of an adverse event defined as the composite of death, intubation, or ICU admission. In total, 57 gynecologic cancer patients with documented COVID-19 positivity were identified. The median age of identified patients was 68 years (range 32 - 91years). 29 patients (50.9%) required hospital admission and 28 (49.1%) patients required supplemental oxygen. 17 patients (30%) experienced an adverse event, defined as the composite of death, intubation, or ICU admission. Specifically 7 (12%) were intubated, 13 (23%) were admitted to the ICU, and 16 (27%) patients died from acute complications of COVID-19. All patients who were intubated and/or admitted to the ICU died from COVID-19 complications. Patients with elevated white blood cell count (WBC), absolute neutrophil count (ANC) and/or elevated prothrombin time (PT) were significantly more likely to experience an adverse event (WBC: 47 vs 12%, p=0.01;ANC: 37 vs 8%, p=0.04;PT: 61 vs 17%, p=0.04). On multivariable analysis, ECOG status of 1 or greater was associated with a 26-fold increase in the odds of an adverse event (OR=26, 95% CI: 2 - 415, p=0.02), and seven or more abnormal lab values was associated with a 305-fold increase in the odds of an adverse event (p=0.007). The presence of active cancer (n=33. 57.9%) or receipt of systemic therapy (n=18, 31.6%) was not associated with the development of an adverse event (p=0.205, p=0.81 respectively). Type of systemic therapy (chemotherapy, immunotherapy, radiation) was not associated with adverse event development. [Display omitted] In this study, we analyzed the outcomes of gynceocologic oncology patients with COVID-19 infections at an urban New York City hospital. Over 50% of patients required hospital admission for COVID-19 related symptoms, with a case fatality rate of 27%. Age, active cancer status, or recent systemic therapy was not associated with subsequent intubation, ICU admission, or mortality, while performance status and multiple abnormal lab values were significant risk factors. Further characterization of associated poor prognostic factors is needed in order to formulate best oncologic practices during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

COVID-19 outcomes of patients with gynecologic cancer in New York City: an updated analysis

Despite a growing body of literature, characterization of COVID-19 infection in patients with gynecologic cancer remains limited. Here we present an update of COVID-19 outcomes in New York City (NYC) from the initial surge of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]). We sought to determine the hospitalization and mortality rates and their associated factors, specifically recent chemotherapy and immunotherapy use. Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 New York City (NYC) area hospital systems. Multivariable logistic regression was utilized to analyze COVID-19 related hospitalization and mortality. Of 193 patients with gynecologic cancer and COVID-19, the median age at diagnosis was 65.0 years (interquartile range, 53.0-73.0 years). A total of 106 of the 193 patients (54.9%) required hospitalization;among the hospitalized patients 13 (12.3%) required invasive mechanical ventilation and 39 (36.8%) required ICU admission. No patients requiring mechanical ventilation survived. A total of 34 of 193 (17.6%) patients died of COVID-19 complications. On multivariable analysis, hospitalization was associated with an age greater than or equal to 65 years (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.11, 4.07), Black race (OR 2.53, CI 1.24, 5.32), performance status greater than or equal to 2 (OR 3.67, CI 1.25, 13.55) and greater than or equal to 3 comorbidities (OR 2.00, CI 1.05, 3.84). Only former or current history of smoking (OR 2.75, CI 1.21, 6.22) was associated with death due to COVID-19 on multivariable analysis. A total of 13 of 34 (38.23%) patients who died of COVID-19 complications received cytotoxic chemotherapy, while 4 of 34 (11.76%) patients received immunotherapy. However, recent cytotoxic chemotherapy use was not predictive of COVID-19 hospitalization or mortality on multivariable analysis. [Display omitted] The case fatality rate among gynecologic oncology patients with COVID-19 infection is 17.6%. Cancer-directed therapy, including immunotherapy use, is not associated with an increased risk of mortality related to COVID-19 infection in this larger cohort. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Does COVID-19 compromise SGO member well-being?

To assess the well-being of members of the gynecologic oncology healthcare team during the coronavirus disease-19 (COVID-19) pandemic using validated survey assessments of professional fulfillment, burnout, anxiety, and depression among Society of Gynecologic Oncology (SGO) members. From June 15th-July 1st 2020, SGO members received a web-based survey consisting of the following validated measures: Professional Fulfillment Index (PFI);Generalized Anxiety Disorder (GAD-2 screener and PHQ-7);Patient Health Questionnaire (PHQ-2 screener and PHQ-9) and Impact of Event Scale-Revised (IES-6). Univariate and multivariate regression analyses were performed to identify factors associated with professional fulfillment, burnout, anxiety, and depression. Among the 254 SGO member respondents (approximately 12%), 58% (147) were ≤45 years, 73% (183) identified as female, and 76% (192) were gynecologic, medical, or radiation oncologists. COVID-19 institutional burden was reported as high/very high (23%, 59), moderate (44%, 110), or low (31%79). Most respondents provided direct patient care (96%, 242), including 22% (52) reported caring for COVID-19 patients. Personal history of COVID-19 infection was reported in 16% (41) of repondents. Among 232 PFI respondents, 58% (134) and 41% (95), respectively, met cutoff values for decreased professional fulfillment and burnout. Of those who completed the GAD (246) and PHQ (251) ultrascreeners, 25% (62) and 17% (42) screened positive for anxiety and depression, respectively. Among these, 41% (21/51) and 27% (10/37) reported potentially clinically significant anxiety and depression, while 18% (9/51) and 32% (12/37) of participant scores correlated with potentially severe depression. A total of 37% (97) reported significant trauma-related stress based on IES-6 scores predictive for post-traumatic stress disorder (PTSD). After multivariate adjustment, decreased professional fulfillment and burnout were significantly associated with screening positive for depression (p=0.005, p=<0.001) and anxiety (p=<0.0001, p=<0.001). Positive depression screening was significantly associated with male gender (p=.027), while positive anxiety screening was associated with female gender (p=0.007). Nurses, physician assistants and other non-physician health care professionals were more likely to screen positive for depression in comparison to physician oncologists (p=.022). When adjusted by demographic variables such as age, race, gender, burden of COVID infection, caring for COVID-19 patients, profession, history of anxiety or depression), no association was found with respect to levels of professional fulfillment or burnout. Our preliminary findings suggest that the majority of SGO members are not professionally fulfilled during the first wave of the COVID-19 pandemic, which represents data that differs from pre-COVID era findings, and indicates a significant impact on professional well-being. Though we observed no association between burden of COVID-19 infection or caring for COVID-19 patients with anxiety, depression, professional fulfillment, or burnout, respondents scores indicated moderate to severe anxiety and depression, and over one-third met IES-6 criteria shown to be correlative to the diagnosis of PTSD. The longevity of these effects is of particular concern. The next phase of our study will re-survey SGO members during the second wave of the pandemic. Findings from this work can target interventions to improve SGO member well-being during current and future threats to psychological resilience. [Display omitted] [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inflammatory markers in gynecologic oncology patients hospitalized with COVID-19 infection.

OBJECTIVE: Elevated inflammatory markers are predictive of COVID-19 infection severity and mortality. It is unclear if these markers are associated with severe infection in patients with cancer due to underlying tumor related inflammation. We sought to further understand the inflammatory response related to COVID-19 infection in patients with gynecologic cancer. METHODS: Patients with a history of gynecologic cancer hospitalized for COVID-19 infection with available laboratory data were identified. Admission laboratory values and clinical outcomes were abstracted from electronic medical records. Severe infection was defined as infection requiring ICU admission, mechanical ventilation, or resulting in death. RESULTS: 86 patients with gynecologic cancer were hospitalized with COVID-19 infection with a median age of 68.5 years (interquartile range (IQR), 59.0-74.8). Of the 86 patients, 29 (33.7%) patients required ICU admission and 25 (29.1%) patients died of COVID-19 complications. Fifty (58.1%) patients had active cancer and 36 (41.9%) were in remission. Patients with severe infection had significantly higher ferritin (median 1163.0 vs 624.0 ng/mL, p < 0.01), procalcitonin (median 0.8 vs 0.2 ng/mL, p < 0.01), and C-reactive protein (median 142.0 vs 62.3 mg/L, p = 0.02) levels compared to those with moderate infection. White blood cell count, lactate, and creatinine were also associated with severe infection. D-dimer levels were not significantly associated with severe infection (p = 0.20). CONCLUSIONS: The inflammatory markers ferritin, procalcitonin, and CRP were associated with COVID-19 severity in gynecologic cancer patients and may be used as prognostic markers at the time of admission.

Racial disparities in patients with coronavirus disease 2019 infection and gynecologic malignancy.

BACKGROUND: Mounting evidence suggests disproportionate coronavirus disease 2019 (COVID-19) hospitalizations and deaths because of racial disparities. The association of race in a cohort of gynecologic oncology patients with severe acute respiratory syndrome-coronavirus 2 infection is unknown. METHODS: Data were abstracted from gynecologic oncology patients with COVID-19 infection among 8 New York City area hospital systems. A multivariable mixed-effects logistic regression model accounting for county clustering was used to analyze COVID-19-related hospitalization and mortality. RESULTS: Of 193 patients who had gynecologic cancer and COVID-19, 67 (34.7%) were Black, and 126 (65.3%) were non-Black. Black patients were more likely to require hospitalization compared with non-Black patients (71.6% [48 of 67] vs 46.0% [58 of 126]; P = .001). Of 34 (17.6%) patients who died from COVID-19, 14 (41.2%) were Black. Among those who were hospitalized, compared with non-Black patients, Black patients were more likely to: have ≥3 comorbidities (81.1% [30 of 37] vs 59.2% [29 of 49]; P = .05), to reside in Brooklyn (81.0% [17 of 21] vs 44.4% [12 of 27]; P = .02), to live with family (69.4% [25 of 36] vs 41.6% [37 of 89]; P = .009), and to have public insurance (79.6% [39 of 49] vs 53.4% [39 of 73]; P = .006). In multivariable analysis, among patients aged <65 years, Black patients were more likely to require hospitalization compared with non-Black patients (odds ratio, 4.87; 95% CI, 1.82-12.99; P = .002). CONCLUSIONS: Although Black patients represented only one-third of patients with gynecologic cancer, they accounted for disproportionate rates of hospitalization (>45%) and death (>40%) because of COVID-19 infection; younger Black patients had a nearly 5-fold greater risk of hospitalization. Efforts to understand and improve these disparities in COVID-19 outcomes among Black patients are critical.