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

      Article info

      Publication history

      Accepted: December 20, 2022
      Received in revised form: December 6, 2022
      Received: June 23, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      D3CODE Team Collaborators:

      Ashley Aaroe, MD; Thomas A Aloia, MD; Lee Andrews II; Kiran K Badami, BS; Janna A Baganz,MA; Pratibha Bajwa, MS; Lori R Baker, BA; Gregory R Barbosa, MBA; Hannah C Beird, BS PhD; Matt Bourgeois; Kristy Brock, PhD; Elizabeth M Burton, MBA; Juan Cata, MD; Caroline Chung, MD; Michael Cutherell; John A. Cuenca, MD; Pierre B Cyr, MA; Bouthaina Dabaja, MD; Hiba Dagher, MD; Kevin M Daniels, BA; Mary Domask, BS; Giulio Draetta, MD PhD; Sarah Fisher, MD; Katy Elizabeth French, MD; Andrew Futreal, PhD; Maria Gaeta, MD; Christopher Gibbons, PhD; Myrna Godoy, MD; Drew Goldstein; Jillian Gunther, MD PhD; Cristhiam Hernandez, MD; Kate Hutcheson, PhD; David Jaffray, PhD; Jeff Jin,PhD ; Teny Matthew John, MBBS; Trey Kell; Mark Knafl, MS; Anai Kothari, MD MS; Rayson C Kwan, BBA; J Jack Lee, PhD; Yue Liao, PhD; Jennifer Litton, MD; Alex Liu, MBA; Kevin W McEnery, MD; Mary McGuire, PhD; Tego Musunuru, MD; Mayoora Muthu, DO; Joseph L. Nates, MD; Craig S Owen, BBa; Priyadharshini Padmakumar, BS; Melody Page; Nicholas Palaskas, MD; Jay J Patel, MCS; Sabitha Prabhakaran, PhD; Pratibha Bajwa, MS; Vinod Ravi,MD; Ludivine Russell, MS; Bilja Sajith, PhD; Paul A Scheet, PhD; Stephanie Schmidt, PhD; Kenna R Shaw, PhD; Sanjay Shete, PhD; Daniel P Shoenthal, MD; Lessley J Stoltenberg, BS; Ishwaria Subbiah, MD; Chuck Suitor, MS; Hussein Tawbi, MD, PhD; Phillip Thompson; Anastasia Turin, BS; Samir Unni; Benju Vicknamparampil, BS; Max C Weber, MBA; John Weinstein, MD PhD; Zoe Williams; Scott E. Woodman, MD PhD; Mark C Wozny, PhD; Carol Wu, MD; Jia Wu, PhD; James C Yao, MD; Chingyi Young, MS; Emily Yu; Steven Zatorski

      Author Contributions: Reddy, Cuenca, Botdorf, Wegner, and Nates had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

      Concept and design: Reddy, Cuenca, Botdorf, Wegner, Gutierrez, Nates

      Acquisition, analysis, or interpretation of data: Reddy, Cuenca, Botdorf, Wegner, Crommett, Gutierrez, Rathi, Abbas, Nates.

      Drafting of the manuscript: Reddy, Cuenca, Hanmandlu.

      Critical revision of the manuscript for important intellectual content: All authors.

      Statistical analysis: Cuenca.

      Administrative, technical, or material support: Sajith, Knafl, Woodman, Nates.

      Supervision: Woodman, Abbas, Nates.

      Identification

      DOI: https://doi.org/10.1016/j.mayocp.2022.12.008

      Copyright

      © 2023 Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research

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