An observational retro-prospective study on patients with head and neck cancer who contracted COVID-19 (HERODOTUS: head and neck cancERs international cOviD-19 collabOraTion).

BACKGROUND

We aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with head and neck cancer (HNC).

METHODS

The HERODOTUS registry is a multicenter observational study which included patients with any HNC and a COVID-19 diagnosis. Clinical data were extracted from medical records of patients from 3/2019 until 12/2022. As the study involved numerous variables that would possibly overlap, a cluster analysis was performed for the prediction of patient death due to COVID-19.

RESULTS

Among 403 COVID-19 positive cases, 76 patients died (all-cause fatality rate 18.8%) ;21 deaths were attributed to COVID-19. On multivariate analysis, poor performance status (OR: 8.96, 95% CI: 2.07-47.86), development of sepsis (OR:8.99, 95% CI:1.48-72.4) or ARDS (OR:11.64, 95% CI:2.53--64.42), administration of chemotherapy (OR: 28.08, 95% CI: 5.49-158.92) and hospitalization (OR:7.32, 95% CI: 2.49-23.3) had a negative impact on survival, whereas vaccination was protective (OR: 0.29, 95% CI: 0.11-0.75). The clustering procedure resulted in the automated creation of four clusters and identified the following determinants of death: COPD, autoimmune disease, squamous/adenocarcinoma histology, disease stage, fever, diarrhea, fatigue, first line immunotherapy/immunochemotherapy, second line chemotherapy/cetuximab, cisplatin, chemoradiation, ARDS, coagulopathy, heart failure, treatment modifications due to COVID-19, surgical complications and vaccination.

CONCLUSIONS

This is the largest cohort of patients with HNC and COVID-19. All-cause fatality rate in patients with HNC and COVID-19 was approximately 19%. Among 41 covariates with discriminatory power analyzed, 20 were identified as major determinants of death. Vaccination was protective against death from COVID-19.