Mechanical Ventilation Rates in Oncology Patients with COVID-19

Low rates raise questions about eligibility for intervention

Case Study in Collaboration: Decreasing Prolonged Post-CABG Ventilation Rates

A National Cancer Institute (NCI)-supported study shows that rates of hospitalization and mortality are high in oncology patients with COVID-19. Rates of invasive mechanical ventilation (IMV), however, are low, suggesting that these patients may not be considered appropriate candidates for critical care interventions for the infection.  

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“Hematologic malignancies and lung cancer are the most common underlying diagnoses in oncology patients requiring hospitalization for COVID-19,” says study coauthor Alok A. Khorana, MD, Director of the Gastrointestinal Malignancies Program at Cleveland Clinic Cancer Center. “The data suggest that critical care interventions may have been deemed of little benefit for this high-risk population during the pandemic.” 

Presented at the American Society of Clinical Oncology’s 2021 annual meeting, the conclusions are from the NCI COVID-19 in Cancer Patients Study (NCCAPS), multicenter longitudinal research in which Cleveland Clinic participated. The initial report represents outcomes in 827 adults enrolled in the study, which is targeted to accrue 2,000 patients who are undergoing treatment of hematologic malignancy or solid tumors and who have COVID-19.

Study findings at a glance

Twenty percent of the 162 participants reported at least one hospitalization for COVID-19, with a median length of stay of seven days. Of the 199 hospitalizations documented, 44 (22.1%) involved care in an intensive care unit (ICU) or high dependency unit. The median stay in the ICU was seven days (range 1-53).

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Of the patients admitted to the ICU, 39% received IMV and 38% received vasopressors while hospitalized. Three-quarters of those hospitalized were discharged to home, whereas 12% required home oxygen and 10% required other assistance. Another 6% of the hospitalizations resulted in discharge to a skilled nursing facility.

Twenty-one percent of the patients with cancer hospitalized for COVID-19 died, versus 56% of those admitted to the ICU and 88% of those who received IMV.

The most common presenting symptoms were dyspnea, fatigue/malaise and fever > 100.4°F, which were seen in approximately 65%, 64% and 49% of the patients, respectively. Neutropenia was a presenting symptom in 9% of patients, and 19% were thrombocytopenic.

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Besides MV and vasopressors, other treatments administered to the patients with cancer during their hospitalizations included prophylactic and therapeutic anticoagulation (63.8%), remdesvir (46.6%), corticosteroids (34.5%), convalescent plasma (17.2%) and anti-spike monoclonal antibodies (0.8%). Of the patients treated with anticoagulants, 45% received them for prophylaxis and 22% for treatment.

The tumor types with the greatest representation in the study were lymphoma (16%), multiple myeloma (13%), acute myeloid leukemia/acute lymphocytic leukemia (12%) and lung (10%). Of the 101 patients with solid tumors, 56 had metastases, the majority of which were from lung cancer (57%).

The NCCAPS study is ongoing. Patients with cancer who tested positive for SARS-CoV-2 virus are eligible and will be followed for two years. The current findings are based on analysis of clinical data, serum specimens and imaging data collected during participants’ first COVID-19-related hospitalizations. Additional data are being collected during subsequent hospitalizations.