As reported in JAMA Oncology by Rini et al, the National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) has identified outcomes associated with COVID-19 in patients with cancer.
Study Details
Between May 2020 and February 2022, the study enrolled adult patients from sites participating in three National Cancer Institute clinical trials networks who were within 14 days of an initial positive SARS–CoV-2 test result using a nucleic acid polymerase chain reaction test or rapid antigen test; patients had to be receiving active treatment for cancer or to have undergone prior stem cell/bone marrow transplantation or CAR T-cell treatment.
Key Findings
Among 1,572 eligible patients, the median age was 60 years (range = 18–93 years); 840 (53.4%) were female; 1,066 (67.8%) had solid tumors, most commonly breast (23.6%) and lung cancer (13.9%), with 683 (64.0%) having metastatic disease; and 506 (32.2%) had hematologic cancer, most commonly multiple myeloma (26.4%) and lymphoma (24.3).
The most common cancer treatments were chemotherapy (34.3%), targeted therapy for solid tumors (14.1%), targeted therapy for hematologic cancers (13.6%), immunotherapy (10.6%), and radiation therapy (10.3%).
At enrollment, 1,013 patients (64.4%) were not vaccinated for SARS–CoV-2; 29.0% were fully vaccinated and 4.3% were partially vaccinated (status unknown for 2.3%).
Among all patients, COVID-19–related mortality at 90 days was 3.0% and did not increase thereafter. The cumulative incidence of death in the first 90 days was highest in patients with lymphoma, intermediate in those with acute leukemia and lung cancer, and lower in those with other solid tumors and other hematologic cancers. Cancer-related mortality was 2.9% at 90 days and increased to 6.6% at 6 months.
In multivariable analysis, receipt of chemotherapy (hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.52–2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR = 1.78, 95% CI = 1.33–2.38) were associated with increased risk for COVID-19–related hospitalization. Vaccination prior to testing positive for infection was associated with lower risk of hospitalization (HR = 0.52, 95% CI = 0.38–0.70).
A total of 1,739 cancer treatment disruptions occurred during 2 years of follow-up; of those, 881 (50.7%) were attributed to COVID-19, with most occurring within the first 30 days.
The investigators concluded: “The results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.”
Larissa A. Korde, MD, MPH, Head, Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, National Cancer Institute National Clinical Trials Network, and others. For full disclosures of all study authors, visit jamanetwork.com.
