LAUSR

Simple Summary Frailty has been strongly associated with deaths from COVID-19 in the general population, especially in the elderly, but it is rarely studied in the context of cancer. In this study of 4312 patients who died with cancer, of whom 282 also had concomitant COVID-19, we found that established risk factors, such as older age, male gender, and being a nursing home resident, were also significant risk factors for patients with cancer. Among the risk factors, frailty, as measured using the Hospital Frailty Risk Score (HFRS), was the strongest one, as well as when controlling for age, sex, comorbidities, and socioeconomic factors. In conclusion, frailty should be addressed in cancer care to a greater extent. Abstract Older age and frailty have been associated with COVID-19 deaths, but frailty has seldom been studied in the context of cancer. The aim of this paper was therefore to study frailty (measured using the Hospital Frailty Risk Score) and other risk factors in patients who died with advanced cancer and a concomitant COVID-19 infection, with special reference to lung cancer. Of 4312 patients who died with cancer, 282 had concomitant COVID-19 (within the last 30 days), and these patients were significantly older, more often men, and residents of nursing homes. They often had less access to specialized palliative care, and they died more often in acute hospital settings. Patients with cancer who died with COVID-19 were more often frail (57% vs. 45%, p = 0.0002), and frailty was independently associated with COVID-19-related deaths, both in univariable and multivariable regression models, as well as when controlling for age, sex, socioeconomic factors on an area level, and comorbidity (measured using the Charlson Comorbidity Index). In the final multivariable model, where patients with cancer who died in nursing homes were excluded, belonging to the high-risk frailty group (OR 2.07 (1.31–3.27), p = 0.002) was the strongest prognostic variable in the model. In a separate analysis of a subgroup of deaths due to lung cancer (n = 653, of which 45 deaths occurred with concomitant COVID-19), the above associations were not significant, possibly due to too-few cases. In conclusion, frailty is a strong predictor of cancer deaths and should be addressed in cancer care.