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Tashkandi E, Al-Abdulwahab A, Basulaiman B, Alsharm A, Al-Hajeili M, Alshadadi F, Halawani L, Al-Mansour M, Alquzi B, Barnawi S, Alghamdi M, Abdelaziz N, Azher R. Mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic: A multicenter population-based retrospective study. Mol Clin Oncol 2021; 14:82. [PMID: 33758663 PMCID: PMC7947946 DOI: 10.3892/mco.2021.2244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Administration of effective anticancer treatments should continue during pandemics. However, the outcomes of curative and palliative anticancer treatments during the coronavirus disease (COVID-19) pandemic remain unclear. The present retrospective observational study aimed to determine the 30-day mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic. Between March 1 and June 30, 2020, all adults (n=2,504) with solid and hematological malignancies irrespective of cancer stage and type of anticancer treatments at five large comprehensive cancer centers in Saudi Arabia were included. The 30-day mortality was 5.1% (n=127) for all patients receiving anticancer treatment, 1.8% (n=24) for curative intent, 8.6% (n=103) for palliative intent and 13.4% (n=12) for COVID-19 cases. The 30-day morbidity was 28.2% (n=705) for all patients, 17.9% (n=234) for curative intent, 39.3% (n=470) for palliative intent and 75% (n=77) for COVID-19 cases. The 30-day mortality was significantly increased with male sex [odds ratio (OR), 2.011; 95% confidence interval (CI), 1.141-3.546; P=0.016], body mass index (BMI) <25 (OR, 1.997; 95% CI, 1.292-3.087; P=0.002), hormone therapy (OR, 6.315; 95% CI, 0.074-2.068; P=0.001) and number of cycles (OR, 2.110; 95% CI, 0.830-0.948; P=0.001), but decreased with Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0-1 (OR, 0.157; 95% CI, 0.098-0.256; P=0.001), stage I-II cancer (OR, 0.254; 95% CI, 0.069-0.934; P=0.039) and curative intent (OR, 0.217; 95% CI, 0.106-0.443; P=0.001). Furthermore, the 30-day morbidity significantly increased with age >65 years (OR, 1.420; 95% CI, 1.075-1.877; P=0.014), BMI <25 (OR, 1.484; 95% CI, 1.194-1.845; P=0.001), chemotherapy (OR, 1.397; 95% CI, 1.089-5.438; P=0.032), hormone therapy (OR, 1.527; 95% CI, 0.211-1.322; P=0.038) and immunotherapy (OR, 1.859; 95% CI, 0.648-4.287; P=0.038), but decreased with ECOG-PS of 0-1 (OR, 0.502; 95% CI, 0.399-0.632; P=0.001), breast cancer (OR, 0.569; 95% CI, 0.387-0.836; P=0.004) and curative intent (OR, 0.410; 95% CI, 0.296-0.586; P=0.001). The mortality risk was lowest with curative treatments. Therefore, such treatments should not be delayed. The morbidity risk doubled with palliative treatments and was highest among COVID-19 cases. Mortality appeared to be driven by male sex, BMI <25, hormonal therapy and number of cycles, while morbidity increased with age >65 years, BMI <25, chemotherapy, hormonal therapy and immunotherapy. Therefore, oncologists should select the most effective anticancer treatments based on the aforementioned factors.
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Affiliation(s)
- Emad Tashkandi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah 21421, Saudi Arabia.,Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Amal Al-Abdulwahab
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Bassam Basulaiman
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia
| | - Marwan Al-Hajeili
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Faisal Alshadadi
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Lamis Halawani
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Medical Oncology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia.,Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Bushra Alquzi
- Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Samar Barnawi
- Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Mohammed Alghamdi
- Department of Medical Oncology, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Nashwa Abdelaziz
- Department of Medical Oncology, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ruqayya Azher
- Community Medicine Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia
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McCoy K, Peterson A, Tian Y, Sang Y. Immunogenetic Association Underlying Severe COVID-19. Vaccines (Basel) 2020; 8:E700. [PMID: 33233531 PMCID: PMC7711778 DOI: 10.3390/vaccines8040700] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
SARS-CoV2 has caused the current pandemic of new coronavirus disease 2019 (COVID-19) worldwide. Clinical outcomes of COVID-19 illness range broadly from asymptotic and mild to a life-threatening situation. This casts uncertainties for defining host determinants underlying the disease severity. Recent genetic analyses based on extensive clinical sample cohorts using genome-wide association studies (GWAS) and high throughput sequencing curation revealed genetic errors and gene loci associated with about 20% of life-threatening COVID-19 cases. Significantly, most of these critical genetic loci are enriched in two immune signaling pathways, i.e., interferon-mediated antiviral signaling and chemokine-mediated/inflammatory signaling. In line with these genetic profiling studies, the broad spectrum of COVID-19 illness could be explained by immuno-pathological regulation of these critical immunogenetic pathways through various epigenetic mechanisms, which further interconnect to other vital components such as those in the renin-angiotensin-aldosterone system (RAAS) because of its direct interaction with the virus causing COVID-19. Together, key genes unraveled by genetic profiling may provide targets for precisely early risk diagnosis and prophylactic design to relieve severe COVID-19. The confounding epigenetic mechanisms may be key to understanding the clinical broadness of COVID-19 illness.
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Affiliation(s)
- Kendall McCoy
- Department of Biology, College of Life and Physical Sciences, Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN 37209, USA; (K.M.); (A.P.)
| | - Autumn Peterson
- Department of Biology, College of Life and Physical Sciences, Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN 37209, USA; (K.M.); (A.P.)
| | - Yun Tian
- Department of Agricultural and Environmental Sciences, College of Agriculture, Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN 37209, USA;
| | - Yongming Sang
- Department of Agricultural and Environmental Sciences, College of Agriculture, Tennessee State University, 3500 John A. Merritt Boulevard, Nashville, TN 37209, USA;
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