Background

The coronavirus disease 2019 (COVID‐19) pandemic has kept the world at ransom and led to unprecedented fears and stress. It has led to severe pressure on the intensive care resources bringing out innovative means to manage the high demand for intensive care services.(1) The spectrum of COVID-19 spans from asymptomatic through moderate to severe. About 5% of all patients and 20% of hospitalized patients with COVID-19 may experience severe manifestations necessitating intensive care unit (ICU) admission.(2) Mortality of COVID-19 patients admitted in the ICU is high. In one meta-analysis,(3) 31 % of patients admitted to the ICU died, while in another, mortality ranged from 0-84.6%, with a pooled mortality of 41.6%.(4)

Cancer patients may be at increased risk of complications and mortality from COVID-19 owing to the systemic effects of malignancy, immune suppression after chemotherapy, treatment-related cardiovascular, renal and pulmonary toxicities, as well as the co-existence of co-morbidities. Active cancer is associated with increased odds of death among patients with COVID-19.(5) In two large series of cancer patients with COVID-19, mortality ranged from 13-28%.(6,7)^6,7 In a meta-analysis of 32 studies, all-cause mortality as well as the need for ICU admission were higher in COVID-19 patients with cancer than those without cancer.(8)¹¹

However data of cancer patients admitted to the ICU with Covid-19 related complications is scarce, possibly due to restriction admission of cancer patients to the ICU in the setting of a pandemic. TMH ICU has been admitting cancer patients with Covid-19 throughout this pandemic. We are uniquely placed to generate data on outcomes of cancer patients with Covid-19 admitted to the ICU, and to determine which patient groups and risk factors are most associated with mortality. We therefore plan to do a retrospective review of the cancer patients admitted to the TMH with Covid-19.

Aims and objective

1) To evaluate the characteristics and outcomes of cancer patients with coronavirus in the Intensive Care Unit 

2) To identify risk factors that might predict poor outcomes

Study design and Methods

We will do a retrospective and prospective chart review of all the patients with Covid-19 admitted to the ICU from the over period from 1^st January 2020 to 31^st December 2021 after taking approval from the ethics committee. We will start the prospective data collection from the date of approval of protocol amendment Version 2.0. We will record all the data such as demographics, primary diagnosis, type of cancer, status of disease, indication for ICU admission, APACHE II Score, SOFA score, length of stay in ICU, duration & type of ventilation, treatments and interventions offered, ICU outcome, hospital outcome and outcome at 30 days after ICU admission.

Primary outcome will be mortality in the ICU for cancer patients with covid-19.

Secondary outcomes would be in-hospital mortality and 30-day mortality for cancer patients with covid-19.

In patients with cancer and Covid-19, we will try to identify significant predictors of mortality such as type of cancers (haematological versus solid tumours), operative versus non-operative admission, high-flow nasal oxygen, mechanical ventilation, severity of illness, vasopressors etc.

Since there have been admissions of staff and relatives of staff and patients who had covid-19 but did not have cancer, we will attempt to determine mortality in the cancer versus non-cancer patients with covid-19 in the ICU.

Inclusion criteria

All adult patients >18 years diagnosed with Covid-19 admitted to the Intensive Care unit in TMH

Exclusion criteria

Post Bone Marrow transplant

Statistical Analysis

Data will be analyzed using SPSS-20 software. Continuous variables will be compared using either Student’s t-test or Mann-Whitney U test depending on whether the data is normally distributed or not.

Categorical data will be analyzed by either Pearson’s chi square or Fisher’s exact test.

A p value of <0.05 will be considered significant.

Univariable and Multivariable regression analysis will be performed to determine factors significantly associated with ICU mortality in patients with cancer and Covid-19.