key: cord-1037833-ttg1xfeu authors: Anantharaman, Archana; Dusendang, Jennifer R.; Schmittdiel, Julie A.; Harzstark, Andrea L. title: SARS‐CoV‐2 Clinical Outcomes in Patients with Cancer in a Large Integrated Health Care System in Northern California date: 2020-12-03 journal: Oncologist DOI: 10.1002/onco.13602 sha: f4a6a1ae3d64376fd12f9734922164d1d093c915 doc_id: 1037833 cord_uid: ttg1xfeu The SARS‐CoV‐2 (COVID‐19) pandemic continues to affect many lives globally. Patients with cancer undergoing potentially immunosuppressive therapies appear to be at particular risk for the disease and its complications. Here, we describe the experience of patients with cancer within Kaiser Permanente, a large, integrated health system in Northern California. Between February 25, 2020, and June 8, 2020, 4,627 patients were diagnosed with COVID‐19, of whom 33 had active cancer treatment within 180 days and 214 had a history of cancer. Patients with active cancer treatment had a statistically higher risk of requiring noninvasive ventilation (odds ratio [OR], 2.57; confidence interval [CI], 1.10–6.01), and there was a nonsignificant trend toward higher risk of death (OR, 2.78; CI, 0.92–8.43). Those with a history of cancer had comparable outcomes to those without cancer. These data demonstrate an increased risk of complications from COVID‐19 for patients with active cancer treatment. The SARS-CoV-2 (COVID-19) pandemic has affected more than 10 million people as of July 2020, with the U.S. reporting the highest number of cases and deaths [1] . Patients with cancer appear to be at particular risk for COVID-19 and its complications. Oncologic societies and health care systems have been modifying guidelines for the care of patients with cancer with emerging data. Based on the experience in China and Italy thus far, the overall trend is toward worse COVID-19 outcomes for those with a diagnosis of cancer, especially those with thoracic malignancies [2] [3] [4] . Northern California was one of the first areas to have documented community transmission within the U.S. Myers et al. reported hospitalization and intensive care unit (ICU) admissions from Kaiser Permanente Northern California (KPNC), a regional integrated health care system serving 4.4 million members, constituting 30% of the area's insured population [5] . We describe the outcomes of those affected by COVID-19 with cancer within KPNC. We included adults with a positive lab test for COVID-19 between February 25, 2020, and June 8, 2020, in this retrospective cohort study. All data were collected from the electronic medical record. Using an internally developed algorithm and chart review, we identified patients who had active treatment for cancer (including infusion chemotherapy, oral chemotherapy, or radiation) in the 180 days prior to COVID-19 diagnosis, patients with a history of cancer documented in the KPNC cancer registry but no active treatment, and patients with no cancer history. Outcomes included emergency department visit, inpatient hospitalization, ICU stay, mechanical ventilation, noninvasive ventilation, and mortality between COVID-19 diagnosis and the first of 45 days after diagnosis or June 9, 2020. We used logistic regression to calculate odds ratios (ORs) and confidence intervals (CIs) of outcomes, adjusting for demographic and clinical characteristics, as well as the week of COVID-19 diagnosis to account for changing testing and treatment guidelines. We completed chart review of patients with active cancer treatment and a COVID-19 diagnosis. The Research Determination Committee for KPNC determined this project does not meet the regulatory definition of research involving human subjects per 45 CFR 46.102(d). cancer, and 4,380 (94.7%) had no diagnosis of cancer. Of the patients with cancer receiving active treatment, the most common cancer diagnoses were breast (n = 9) and hematologic (n = 7). The most common treatments were targeted (n = 14), chemotherapy (n = 12), and hormonal (n = 11). Patients with active cancer treatment or a history of cancer were older and more likely to be white, had higher Charlson comorbidity scores and lower body mass index, and were more likely to have hypertension and diabetes and to have ever smoked than patients without cancer (Table 1) . Patients with active cancer treatment had a higher risk of requiring noninvasive ventilation (OR, 2.57; CI, 1.10-6.01) than those without cancer. There was a nonstatistically significant trend toward higher risk of death Those with a history of cancer had comparable outcomes to those without any cancer history (Table 2) . There was an increased risk of requiring noninvasive ventilation and a non-statistically significant increased risk of death, consistent with prior data demonstrating an increased risk of complications from COVID-19 for patients on active cancer therapy [3, 6] . Patients with a history of cancer appear to have similar outcomes to those without a history of cancer. This supports questions around whether treatment, with its impact on the immune system and additional touchpoints with the medical center, may pose significant risk for patients with an active diagnosis of cancer. Evaluating these factors in a larger population may further answer these questions. Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China Thoracic cancERs international coVid 19 cOLlaboraTion): First results of a global collaboration to address the impact of COVID-19 in patients with thoracic malignancies Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California Outcome of cancer patients infected with COVID-19, including toxicity of cancer treatments. Abstract presented at The authors indicated no financial relationships.