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

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. [Figure: see text] CONCLUSIONS: 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.