Evaluation of COVID-19 Mortality and Adverse Outcomes in US Patients With or Without Cancer

Abstract

As the COVID-19 pandemic continues, understanding the clinical outcomes of patients with cancer and COVID-19 has become critically important.OBJECTIVE To compare the outcomes of patients with or without cancer who were diagnosed with COVID-19 and to identify the factors associated with mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization. DESIGN, SETTING, AND PARTICIPANTSThis cohort study obtained data from the Optum de-identified COVID-19 electronic health record data set. More than 500 000 US adults who were diagnosed with COVID-19 from January 1 to December 31, 2020, were analyzed.EXPOSURES The patient groups were (1) patients without cancer, (2) patients with no recent cancer treatment, and (3) patients with recent cancer treatment (within 3 months before COVID-19 diagnosis) consisting of radiation therapy or systemic therapy.MAIN OUTCOMES AND MEASURES Mortality, mechanical ventilation, ICU stay, and hospitalization within 30 days of COVID-19 diagnosis were the main outcomes. Unadjusted rates and adjusted odds ratios (ORs) of adverse outcomes were presented according to exposure group.RESULTS A total of 507 307 patients with COVID-19 were identified (mean [SD] age, 48.4 [18.4] years; 281 165 women [55.4%]), of whom 493 020 (97.2%) did not have cancer. Among the 14 287 (2.8%) patients with cancer, 9991 (69.9%) did not receive recent treatment and 4296 (30.1%) received recent treatment. In unadjusted analyses, patients with cancer, regardless of recent treatment received, were more likely to have adverse outcomes compared with patients without cancer (eg, mortality rate: 1.6% for patients without cancer, 5.0% for patients with no recent cancer treatment, and 7.8% for patients with recent cancer treatment). After adjustment, patients with no recent cancer treatment had similar or better outcomes than patients without cancer (eg, mortality OR, 0.93 [95% CI, 0.84-1.02]; mechanical ventilation OR, 0.61 [95% CI, 0.54-0.68]). In contrast, a higher risk of death (OR, 1.74; 95% CI, 1.54-1.96), ICU stay (OR, 1.69; 95% CI, 1.54-1.87), and hospitalization (OR, 1.19; 95% CI, 1.11-1.27) was observed in patients with recent cancer treatment. Compared with patients with nonmetastatic solid tumors, those with metastatic solid tumors and hematologic malignant neoplasms had worse outcomes (eg, mortality OR, 2.36 [95% CI,; mechanical ventilation OR, 0.87 [95% CI, 0.70-1.08]). Recent chemotherapy and chemoimmunotherapy were also associated with worse outcomes (eg, chemotherapy mortality OR, 1.84 [95% CI, 1.51-2.26]).CONCLUSIONS AND RELEVANCE This cohort study found that patients with recent cancer treatment and COVID-19 had a significantly higher risk of adverse outcomes, and patients with no recent cancer treatment had similar outcomes to those without cancer. The findings have risk stratification and resource use implications for patients, clinicians, and health systems.

The Outcome of Gynecologic Cancer Patients With Covid-19 Infection: A Systematic Review And Meta-Analysis

“…5,62,63 Lastly, most studies also support our findings on the increased Covid-19 adverse outcome in hematologic cancer population with 34.2% case fatality rate (480 hematologic cancer), (120 hematologic cancer, 758 control, OR 2.39, CI 1.17-4.87, p 0.02, I 2 49%) in other meta analyses. 62,63,65-68. We believe our meta-analysis results correspond to several studies that present the safety of continuing gynecologic cancer care and service during the global pandemic.…”

“…[5][6][7][61][62][63][64][65] 66 Our finding shows gynecologic cancer with metastatic disease has an increased Covid-19 death compared to whose cancer are localized (OR 1.53, CI 1.06-2.21, p 0.02, I 2 0%), most studies also report identical outcomes to ours. 65,67,68 Our analysis also shows gynecologic cancer is associated with higher Covid-19 death and hospitalization compared to breast cancer patients (OR 1.51, CI 1.20-1.90, p 0.0004, I 2 21%), (OR 1.52, CI 1.18-1.96, p 0.001, I 2 0%) respectively. Other meta-analyses, as well as studies done by "CCC19" and the "N3C" also supported this finding.…”

“…[5][6][7][61][62][63][64][65] In this meta-analysis gynecologic cancer patients is at increased risk of Covid-19 death compared to the non-cancer population (OR 3.06, CI 2.32-4.04, p <0.0001, I 2 28%), most studies also support this finding by providing evidence of greater Covid-19 adverse outcome in cancer patients. [5][6][7][61][62][63][64][65] 66 Our finding shows gynecologic cancer with metastatic disease has an increased Covid-19 death compared to whose cancer are localized (OR 1.53, CI 1.06-2.21, p 0.02, I 2 0%), most studies also report identical outcomes to ours. 65,67,68 Our analysis also shows gynecologic cancer is associated with higher Covid-19 death and hospitalization compared to breast cancer patients (OR 1.51, CI 1.20-1.90, p 0.0004, I 2 21%), (OR 1.52, CI 1.18-1.96, p 0.001, I 2 0%) respectively.…”

Clinical Management of COVID-19 in Cancer Patients with the STAT3 Inhibitor Silibinin

“…Patients with both cancer and COVID-19 infection often have a more severe clinical course with worse outcomes, and lethality rates of up to 25%. Indeed, the risk of adverse outcomes of SARS-CoV-2 infection is significantly higher for patients with cancer than for the general population across a broad spectrum of malignancies; the patients are often immunocompromised and older (aged ≥ 60 years) with one or more comorbidities [36][37][38][39][40][41][42][43][44][45]. Because of the higher risk of severe evolution of COVID-19, a more intensive surveillance strategy should be incorporated into the clinical management of cancer patients (especially those with active malignancy), including early evaluation of symptoms and early treatment for COVID-19.…”

Cross-Sectional Survey of Smoking Patterns During the COVID-19 Pandemic in a Tobacco Cessation and Lung Cancer Screening Program

“… 3 COVID-19 has also adversely impacted screening, 4 diagnosis, 5 and survival from lung cancer. 6 Moreover, concerns have been raised about adverse effects of the COVID-19 pandemic on smokers trying to quit in the United States. 7 …”