Mortality Risk in Patients With Cancer and SARS–CoV-2 Higher Among Older Patients With B-Cell Malignancies and Those Who Previously or Currently Smoke

ASCO COVID-19 Registry Continues to Recruit Practices for Ongoing Research

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A recent study published in JCO Oncology Practice found that patients with certain cancers have a higher mortality risk than those with other cancer types if they have contracted the novel coronavirus (SARS–CoV-2).1 Specifically, older patients with B-cell malignancies who acquire SARS–CoV-2 who are undergoing cancer treatment are at increased risk of death compared with other patients who have cancer. Previous or current tobacco users who are undergoing cancer treatment are also at increased risk of death if they test positive for SARS–CoV-2.

Analyzing patient outcomes from the ASCO Survey on COVID-19 in Oncology Registry (ASCO Registry), the study examined mortality rates at 30 and 90 days after testing positive for the virus in people with cancer who are undergoing anticancer drug-based therapy and who had not been vaccinated. The study found that patients aged 61 to 70 with B-cell malignancies had twice the mortality risk and patients older than 70 had 4.5 times the mortality risk, compared with patients younger than 60. Current and previous tobacco use also increased the risk of mortality, with a 30-day mortality estimate of 21% for tobacco users, compared with 11% for those who never used tobacco.

The implications of the study suggest that other risk factors (eg, race, ethnicity) associated with poor outcomes in unvaccinated patients with COVID-19 and without cancer may be mitigated in this patient population. That is, in the presence of cancer, for example, race and/or ethnicity does not appear to be associated with mortality risk. This suggests that cancer displaces certain other risk factors as they relate to mortality and the severity of COVID-19.

The study also looked at the impact of COVID-19 on cancer care treatment; it found that 49% of patients undergoing drug-based anticancer therapy delayed one or more anticancer treatments. An additional 16% discontinued one or more treatments. Another 35% continued their treatment without change. Overall, delays and discontinuations of treatments were common, pointing to a need to track and further analyze the impact of these treatment changes.

Preliminarily selected for discussion and presented as a poster at the 2021 ASCO Annual Meeting, the study used ASCO Registry data provided by 38 oncology practices from April 2020 through October 2020. It represents the experiences of 453 patients who were undergoing anticancer treatment during 2020 and prior to the availability of COVID-19 vaccines.

ASCO COVID-19 Registry: Practice Recruitment Still Open

The ASCO Registry collects longitudinal data on patients actively undergoing cancer treatment and who have a confirmed SARS–CoV-2 infection. The data collected are stored in CancerLinQ’s secure cloud.

As of October 26, 2021, the ASCO Registry has data from 66 U.S. oncology practices on more than 4,800 patients. The Registry Data Dashboard provides a graphic overview of patient demographics and information about cancer types, comorbidities, cancer treatments, and COVID-19 symptoms.

As shown in the dashboard, ASCO has heightened interest in improving the U.S. geographic footprint of its Registry practices (with retrospective and prospective data)—particularly in the Southwest (Arizona, Colorado, New Mexico, Nevada, Oklahoma, Texas, Utah) and Midwest (Minnesota, Wisconsin, Iowa). ASCO provides a per-case stipend at 30 days after a positive SARS–CoV-2 test and a subsequent stipend at 24 months after a positive test.

ASCO urges all oncology practices to sign up for the COVID-19 Registry to help the cancer community learn more about the patterns of symptoms and the severity of COVID-19 among patients with cancer, as well as how the coronavirus is impacting the delivery of cancer care and patient outcomes. The data collection period has been extended to enable tracking of additional vaccine doses and COVID-19 reinfections. Please enroll now at or contact for additional information or questions.

COVID-19 Vaccination and the Oncology Community

Although coronavirus outbreaks in the United States have slowed, the data in these findings continue to be relevant in areas with low vaccination rates and surging COVID-19 variant infections. Underscoring that patients with cancer are at higher risk for severe disease if they are infected with SARS–CoV-2, ASCO encourages its members to receive the COVID-19 vaccinations to protect themselves and their patients—and has developed a useful Cancer.Net COVID-19 fact sheet for cancer care teams to share with people with cancer and their families. Visit ASCO’s COVID-19 Resources Page at for the most current information and additional resources on the coronavirus that ASCO is providing for its members and the larger oncology community. 


1. Mileham KF, Bruinooge SS, Aggarwal C, et al: Changes over time in COVID-10 severity and mortality in patients undergoing cancer treatment in the United States: Initial report from the ASCO registry. J Oncol Pract. October 25, 2021 (early release online).

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