In a cohort study reported in JAMA Oncology, Mariana Chavez-MacGregor, MD, MSc, and colleagues found that patients with cancer infected with COVID-19 had poorer outcomes vs patients without cancer if they had received recent cancer treatment. Patients with cancer who had not received recent treatment had similar outcomes to those without cancer.
Mariana Chavez-MacGregor, MD, MSc
Study Details
The study involved data from the Optum de-identified COVID-19 electronic health record data set on 507,307 U.S. adults diagnosed with COVID-19 from January 1 to December 31, 2020.
Rates of mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization within 30 days of COVID-19 diagnosis were analyzed among patients without cancer, patients with cancer who received radiotherapy or systemic therapy within 3 months before COVID-19 diagnosis (recent treatment group), and patients with cancer who did not receive recent treatment. Analyses were adjusted for age, comorbidity, sex, race/ethnicity, severe obesity, skilled nursing facility stay within 3 months before COVID-19 diagnosis, 2020 calendar quarters, insurance type, and region.
Key Findings
Among the 507,307 patients with COVID-19 (mean age = 48.4 ±18.4 years; 55.4% women), 493,020 (97.2%) did not have cancer. Among the 14,287 patients with cancer (2.8%), 9,991 (69.9%) did not receive recent treatment and 4,296 (30.1%) received recent treatment.
In unadjusted analyses, patients with cancer were more likely to have adverse outcomes of infection vs those without cancer regardless of recent vs no recent treatment; eg, COVID-19 mortality rates at 30 days were 1.6% for patients without cancer, 5.0% for patients with no recent cancer treatment, and 7.8% for patients with recent cancer treatment.
In adjusted analysis, compared with patients without cancer, patients with cancer who had not received recent treatment had a significantly reduced risk of mechanical ventilation (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.54–0.68) and hospitalization (OR = 0.79, 95% CI = 0.75–0.83) at 30 days, with no significant differences in risk for mortality (OR = 0.93, 95% CI = 0.84–1.02) or ICU stay (OR = 0.98, 95% CI = 0.91–1.06).
This cohort study found that patients with recent cancer treatment and COVID-19 had a significantly higher risk of adverse outcomes, and patients with no recent cancer treatment had similar outcomes to those without cancer. The findings have risk stratification and resource use implications for patients, clinicians, and health systems.— Mariana Chavez-MacGregor, MD, MSc, and colleagues
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Compared to patients without cancer, those with cancer who had undergone recent treatment had a significantly greater risk of 30-day mortality (OR = 1.74, 95% CI = 1.54–1.96), ICU stay (OR = 1.69, 95% CI = 1.54–1.87), and hospitalization (OR = 1.19, 95% CI = 1.11–1.27), with no difference in risk of mechanical ventilation (OR = 1.00, 95% CI = 0.88–1.13).
Among all patients with cancer, compared with patients with nonmetastatic solid tumors, those with metastatic solid tumors had a significantly greater risk of mortality (OR = 2.36) and hospitalization (OR = 1.37); those with hematologic malignancies had a significantly greater risk of mortality (OR = 1.72), mechanical ventilation (OR = 1.42), ICU stay (OR = 1.29), and hospitalization (OR = 1.44).
Among patients with cancer receiving vs not receiving systemic treatment within 3 months of COVID-19 diagnosis, both chemotherapy and chemoimmunotherapy were associated with a significantly increased risk of mortality (ORs = 1.84 and 2.31), mechanical ventilation (ORs = 1.74 and 3.64), ICU stay (ORs = 2.21 and 3.29), and hospitalization (ORs = 1.40 and 2.22). Immunotherapy alone was associated with an increased risk of mechanical ventilation but not other adverse outcomes.
The investigators concluded, “This cohort study found that patients with recent cancer treatment and COVID-19 had a significantly higher risk of adverse outcomes, and patients with no recent cancer treatment had similar outcomes to those without cancer. The findings have risk stratification and resource use implications for patients, clinicians, and health systems.”
Sharon H. Giordano, MD, MPH, of the Department of Health Services Research, The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
