Impact of Cancer History on Outcomes Among Hospitalized Patients with COVID-19

Abstract

Background. Early reports suggested increased mortality from COVID-19 in patients with cancer but lacked rigorous comparisons to non-cancer patients. We investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death in hospitalized COVID-19 patients. Patients and Methods. We identified patients with a history of cancer admitted to 2 large hospitals between 3/13/2020 and 5/10/2020 with laboratory-confirmed COVID-19 and matched them 1:2 to patients without a history of cancer. Results. 56.2% of the population was male, with a median age of 69 years (range: 30-96). The median time since cancer diagnosis was 35.6 months (range 0.39-435); 80% had a solid tumor and 20% had a hematologic malignancy. Among patients with cancer, 27.8% died or entered hospice vs. 25.6% among patients without cancer. In multivariable analyses, the odds of death/hospice were similar (OR: 1.09, 95%CI: 0.65-1.82). The odds of intubation (OR: 0.46, 95%CI: 0.28-0.78), shock (OR: 0.54, 95%CI: 0.32-0.91), and intensive care unit admission (OR: 0.51, 95%CI: 0.32-0.81) were lower for patients with a history of cancer vs. controls. Patients with active cancer or who had received cancer-directed therapy in the past 6 months had similar odds of death/hospice compared to cancer survivors (univariable OR: 1.31, 95%CI: 0.66-2.60; multivariable OR: 1.47, 95%CI: 0.69-3.16). Conclusions. Patients with a history of cancer hospitalized for COVID-19 had similar mortality to matched hospitalized COVID-19-positive patients without cancer, and a lower risk of complications. In this population, patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared to cancer survivors. The Oncologist 2021;9999:• • Implications for Practice: An understanding of the comorbidities and patient characteristics that portend a severe outcome from COVID-19 can improve patient care and guide the utilization of scare resources. To develop this understanding, we investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death or hospice admission in hospitalized COVID-19 patients. We found that active cancer, systemic cancer therapy, and a history of cancer are not independent risk factors for death from COVID-19 among hospitalized patients, and hospitalized patients without cancer are more likely to have severe COVID-19 marked by intubation, ICU admission, ARDS, and shock. These findings provide reassurance to cancer survivors and patients as to their relative risk of severe COVID-19, may encourage oncologists to provide standard anti-cancer therapy in patients at risk of COVID-19, and guide triage in future waves of infection.

Association of government effectiveness, logistics performance, IT systems and income with COVID-19 mortality

“…Also, medical scientists and social scientists alike have undertaken studies from diverse perspectives both at pharmacological and non-pharmacological levels. Studies conducted at patients-level on the impact of COVID-19 by varied dimensions - such as, sex differences [ [2] , [3] , [4] , [5] ] underlying diseases [ [6] , [7] , [8] , [9] ] and physical fitness [ [10] , [11] , [12] ] - have come up with varied findings. Studies by these dimensions have contributed to further analysis and understanding of the risk factors and fatalities associated with COVID-19.…”

Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014–2020

“…Consequently, we suspect that differences in inpatient versus outpatient site of care, treatment course, and disease morbidity in our NHIS sample contributed to this finding. Previous studies have described differences in clinical morbidity and outcomes of patients with blood cancers and found that patients with blood cancers were more likely to die after hospitalization with COVID-19 [ 40 , 41 ] and were more likely to die in the hospital and receive intensive care compared to patients with solid tumors [ 30 , 31 , 42 ]. Although limited in scope of analysis, these studies point to higher baseline morbidity and need for inpatient care of patients with blood cancers.…”