COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study

Abstract

Background Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. Objective The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. Methods We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. Results During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre–COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. Conclusions The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population.

Real-World Evidence of the Impact of the COVID-19 Pandemic on Lung Cancer Survival: Canadian Perspective

“…In our previous research publications [ 12 , 13 ], we highlighted a significant decline in the incidence of new lung cancer cases during the initial phase. This observation is consistent with widespread global reports documenting similar trends [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Following the decline witnessed initially, we observed a significant resurgence in the incidence of new cases, with an escalation of 79% during the second year of the pandemic.…”

“…Numerous studies have shed light on a concerning phenomenon within the realm of oncology: a marked decline in the detection of new lung cancer cases coupled with a concerning shift in the stage at which these malignancies are being diagnosed. These studies collectively underscore the profound impact that the pandemic, particularly its initial lockdown measures, has had on lung cancer diagnosis and presentation [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

Dying with Cancer and COVID-19, with Special Reference to Lung Cancer: Frailty as a Risk Factor

“…During the first wave, patients with active cancer were discussed as being a potentially vulnerable group both due to the malignancy itself and immunosuppressive treatments, which has since been verified [ 5 , 6 , 7 , 8 ]. The first cancer studies confirmed that age and comorbidity were risk factors for mortality [ 9 ], and recent studies on large groups have corroborated that advanced age, male sex, and comorbidities are associated with poorer outcomes, especially in patients with active cancer and ongoing treatment [ 10 , 11 ]. A recent study revealed that unvaccinated patients with cancer still constitute a vulnerable group, highly susceptible to SARS-CoV-2 infections with poor outcomes [ 12 ].…”

Scientific Publications on Nursing for COVID-19 in Patients With Cancer: Scoping Review

“…The SARS-CoV-2 infection has a mild course in most people, but in a significant portion of the population, the condition progresses to a severe respiratory disease characterized by hyperinflammatory syndrome, multiple-organ dysfunction, and death [ 8 ]. This is because some patient subgroups, such as the elderly and individuals with chronic conditions, such as hypertension, diabetes, and chronic lung diseases, have been shown to have an increased risk of morbidity and mortality when affected by COVID-19 [ 9 ].…”

“…Literature data indicate that patients with cancer undergoing active treatment are at greater risk of developing serious events related to COVID-19, requiring admission to an intensive care unit [ 10 ]. There are reports of early studies from China that demonstrated a 2- to 4-fold increase in COVID-19 mortality among patients with cancer compared to those without cancer, while other smaller studies reported a 29% case fatality rate and worse outcomes among patients with cancer infected with COVID-19 [ 9 ].…”