Mortality Rate of Patients with Gynecological Cancers and COVID-19 Similar to Age Specific Risk

With the arrival of COVID-19 in the United States, New York City became the epicenter of the pandemic, drastically impacting the lives of thousands as health care professionals from all medical fields tried to understand the full effects of the virus.

In trying to understand these effects, researchers looked at the impact of patients with gynecological cancer who have COVID-19, finding that they have a similar risk of death to the age-specific mortality risk of COVID-19.

In a recent study, published in Cancer, researchers gathered data from six New York City area hospital systems to look at 121 patients with known gynecological cancers and a COVID-19 diagnosis to assess the clinical outcomes of these patients. The researchers aimed to understand the varied impacts of COVID-19 on different patient populations.

What they found was that the case fatality rate among these patients with gynecologic cancers and COVID-19 was 14%, which was comparable to the mortality rate in 5,700 patients from New York City diagnosed with COVID-19 (21%).

When looking at the patients with gynecologic cancers, the researchers also found that the median age of patients also diagnosed with COIVD-19 was 64 years, compared with 63 years in the general population.

Females represented 39.7% of these cases with 6% having cancer. The most common cancers included high‐grade serous ovarian, fallopian tube, or primary peritoneal cancer in 33 patients (27.3%); low‐grade endometrioid endometrial carcinoma in 26 patients (21.5%); high‐grade endometrial carcinoma in 22 patients (18.2%); and cervical carcinoma in 13 patients (10.7%). Moreover, 62.7% of patients had advanced stage disease. Sixty-six patients in the study group required hospitalization, 45 needed respiratory intervention, 20 were admitted to the ICU and nine underwent invasive mechanical ventilation — however, no patient requiring this intervention survived.

In total, 17 patients died from COVID-19 complications. Recent immunotherapy use was found to be significantly related to the mortality rate of patients with gynecological cancers infected with COVID-19. However, the researchers did not find a significant link between the mortality rate and the 35 patients who recently underwent cytotoxic chemotherapy or the 11 who had cancer-directed surgery. Eight patients were on immunotherapy and 13 were using targeted immune therapies, which made them more susceptible to the severe side effects of the virus.

“Among hospitalized patients, no differences were seen in the distribution of patients with evidence of disease or types of cancer‐directed therapy,” the researchers explained. “Patients who died were more likely to be older, be African American, have three or more comorbidities, and have previously used immunotherapy.”

Compared to white patients with gynecological cancers, Black patients were 1.56 times more likely to be hospitalized. In addition, if patients had three or more comorbidities, they were 1.43 times more likely to be hospitalized.

Among all patients with cancer diagnosed with COVID-19 in New York City area hospitals, the highest mortality rate of any cancer site was patients with lung cancer (55%). The researchers noted that there were tumor-specific differences that impacted COVID-19 survival and that further evaluation was needed.

They also found, among the larger cohort of patients with gynecological cancers, the case fatality rate was similar, but that all patients who required mechanical ventilation survived. In comparison, severely ill patients with cancer who require mechanical intervention have seen mortality rates drop over the past 20 years to 63%, suggesting a unique association between patients with cancer and COVID-19.

“Nonetheless, patients with gynecologic cancer who are hospitalized for COVID‐19 can be counseled that almost 75% will recover and be discharged,” the researchers concluded.