Clinical Outcomes of patients with cancer before the SARS COV2 pandemic vs during the pandemic: A Nationwide Analysis.

person Siri Chandana Swarna John H. Stroger, Jr. Hospital of Cook County, Chicago, IL info_outline Siri Chandana Swarna, Vaishali Deenadayalan, Ali Shahbaz Shehbaz Baloch, Junglee Kim, Shweta Gupta

Authors person Siri Chandana Swarna John H. Stroger, Jr. Hospital of Cook County, Chicago, IL info_outline Siri Chandana Swarna, Vaishali Deenadayalan, Ali Shahbaz Shehbaz Baloch, Junglee Kim, Shweta Gupta Organizations John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, Weiss Memorial Hospital, Chicago, IL Abstract Disclosures Research Funding No funding received None. Background: The novel SARS COV2 pandemic has disrupted cancer treatment, both preventive as well as treatment services. We aimed to study the clinical outcomes of cancer patients who were hospitalised before and during the pandemic. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016-2020 was queried to identify adult patients (Age > 18 years) with a diagnosis of cancer using the ICD-10 (International Classification of Diseases) codes. Study population was stratified based on the year of admission- 2016 to 2019 vs 2020 (the pandemic year). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 18 million admissions in adults with cancer from 2016-2020. Among them 14.6 million (81.1%) were hospitalised during 2016-2019 (pre pandemic) whereas 3.4 million (18.9%) were hospitalized in 2020 (pandemic). There was no significant difference in the mean age of both groups, pandemic group had higher charlson comorbidity burden (66.4 vs 63.7%, p < 0.01). Pandemic group had higher rates of DM (26 vs 24%), CHF (15 vs 13.8%), CKD (18 vs 16.5%), dyslipidemia (36.4 vs 33%), PEM (15 vs 13%), anemia (44 vs 42) all p < 0.01. A total of 835,065 cancer patients died during the study period, the mortality rate in the pre-pandemic and pandemic years was 4.5% and 5% respectively (p < 0.05). After adjusting for confounders, the all-cause mortality was increased in the pandemic group (aOR 1.10, 95% CI 1.05-1.12, p < 0.01). The adjusted LOS was decreased by 0.1 days (95% CI: 0.06- 0.20, p < 0.01)). The adjusted total hospitalization charges was increased by $12,891 (95% CI: 9745-16,035, p < 0.01). Pandemic group had higher odds of sepsis (7.8 vs 6.5%), mechanical ventilation (4 vs 3%), pressor requirements (1.5 vs 1%), acute kidney injury (10 vs 7%) and acute respiratory failure (10 vs 7%), all p < 0.01. Conclusions: During the COVID-19 pandemic, cancer patients with a high prevalence of medical comorbidities were more likely to be admitted to the hospital with COVID infection. The higher mortality in these patients was likely the result of higher secondary complications, also likely leading to earlier death explaining the lower LOS and higher hospitalization charges. Cancer patients with medical comorbidities should take higher preventive measures from COVID including encouraging continued primary vaccinations and regular boosters.