In a study reported in JAMA Oncology, Wang et al found that patients with cancer were at a greater risk of being infected with COVID-19 and having worse outcomes vs patients without cancer. Risk was greatest among patients with a more recent diagnosis and was even further exacerbated among Black patients.
Study Details
The study was a retrospective case-control analysis of patient electronic health records (EHRs) through August 14, 2020. The odds of COVID-19 infection among patients with 13 common cancer types and the adverse outcomes of COVID-19 infection were analyzed. The adjusted odds ratios (ORs) were calculated by controlling for age groups, sex, race (White or Black), and common comorbidities considered risk factors for COVID-19 infection.
Key Findings
As of August 14, 2020, the study population consisted of 73,449,510 patients with EHRs, including 2,523,920 with at least 1 of the 13 common cancers (all diagnosed within or before the last year), and 273,140 with cancer diagnosed within the last year (recent diagnosis).
A total of 16,570 patients were diagnosed with COVID-19, including 1,200 with cancer diagnosed within the past year or prior to the past year and 690 with recent diagnosis.
Compared to patients without cancer, those with cancer (adjusted odds ratio [OR] =1.46, 95% confidence interval [CI] = 1.42–1.50, P < .001) and those with recent cancer diagnosis (adjusted OR = 7.14, 95% CI = 6.91–7.39, P < .001) were at significantly increased risk of COVID-19 infection.
Patients with recent diagnosis of cancer had significantly increased risk for COVID-19 infection for all 13 cancer types. The strongest associations were for leukemia (adjusted OR = 12.16, P < .001), non-Hodgkin lymphoma (adjusted OR = 8.54, P < .001), lung cancer (adjusted OR = 7.66, P < .001), liver cancer (adjusted OR = 6.49, P < .001), and pancreatic cancer (adjusted OR = 6.26, P < .001). Weaker but significant associations were observed for thyroid cancer (adjusted OR = 3.10, P < .001) and endometrial cancer (adjusted OR = 4.70, P < .001).
Among patients with recent cancer diagnosis, Black patients were at significantly higher risk for COVID-19 infection vs White patients, with the disparities being greatest for patients with breast cancer (adjusted OR = 5.44, P < .001), prostate cancer (adjusted OR = 5.10, P < .001), colorectal cancer (adjusted OR = 3.30, P < .001), and lung cancer (adjusted OR = 2.53, P < .001).
The overall hospitalization rate among 15,510 adult patients with COVID-19 was 25.27%. Among 670 adult patients with COVID-19 and recent cancer diagnosis, 320 (47.76%) were hospitalized, with higher hospitalization rates for Black patients (150 of 270, 55.56%) vs White patients (160 of 370, 43.24%; P = .003).
The overall death rate among adult patients with COVID-19 was 5.61%. The death rate in adult patients with COVID-19 and cancer was 14.9%, with no significant difference between Black and White patients (18.52% vs 13.51%, P = .11).
The investigators concluded, “In this case-control study, patients with cancer were at significantly increased risk for COVID-19 infection and worse outcomes, which was further exacerbated among [Black patients]. These findings highlight the need to protect and monitor patients with cancer as part of the strategy to control the pandemic.”
Nathan A. Berger, MD, and Rong Xu, PhD, of the School of Medicine, Case Western Reserve University, are the corresponding authors for the JAMA Oncology article.
Disclosure: This study was supported by grants from the National Institutes of Health, American Cancer Society, and others. For full disclosures of the study authors, visit jamanetwork.com.
