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Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19

Published:December 27, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.12.008
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      Abstract

      There is scant information on the clinical progression, end-of-life decisions, and cause of death of cancer patients diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death of death three board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion between the three reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were non-survivors. Among non-survivors, thirty-one (51%) patients had hematological, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% CI, 11.8-18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission; however, 53 (87%) had a Do-Not-Resuscitate order at the time of death. Most deaths were deemed to be COVID-19-related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents perish due to their comorbidities, in our study only one of every ten patients died of cancer–related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with non-resuscitative measures rather than full support at the end of life.

      Keywords

      Abbreviations:

      COVID-19 (Coronavirus disease 2019), D3CODE (Data-Driven Determinants of COVID-19 Oncology Discovery Effort), SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2)