Critically Ill Cancer Patients at High Risk of Severe COVID-19, Mortality

Researchers from Memorial Sloan Kettering Cancer Center found 68% of patients with cancer who also acquired COVID-19 and went into acute respiratory failure in the ICU required invasive mechanical ventilation (MV). In their study, 39% of the cancer patients who required mechanical ventilation died in the ICU. The research presented at Chest 2020 adds to the growing body of evidence regarding the high risk of mortality for patients with cancer and significant comorbidities in the fight against COVID-19.

During the study period, a total of 290 patients were admitted to two ICUs; 90 (31%) had active or a recent history of cancer and COVID-19 pneumonia. Advanced stage non-small cell lung cancer and breast cancer were the most frequent solid tumors, and leukemia and lymphoma were the most common hematologic cancers. The mean age of patients was 65 years; 60% were men, 67% were white, 49% had hypertension, 29% had diabetes and 50% had a smoking history.

Acute respiratory failure (ARF) leading to invasive mechanical ventilation developed in 61 patients (68%) who had a mean of 25 days of being supported by MV. Prone positioning (self or during MV) was implemented in 44 patients (49%). Eighteen patients (30%) were extubated after a mean of 11.5 days; 16 (26%) underwent a tracheostomy, 10 (63%) of whom were successfully liberated from MV. Thirty-six patients (40%) had a do-not-resuscitate order during their ICU stay.

By the end of the 11-week study period, 24 (39%) of the patients who required MV died compared with 5 (17%) of the 29 nonventilated patients. Forty patients (44%) were discharged home, and 26 (29%) remained hospitalized.

“Critically ill cancer patients with COVID-19 are at high risk of severe disease and mortality. Nearly 40% of cancer patients with COVID-19 in our study did not survive after developing acute respiratory failure requiring mechanical ventilation in the ICU. More research should be conducted to better understand how to best care for these vulnerable patients,” said Michael Dang, MD, researcher and CHEST 2020 presenter.