Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada

Abstract

PURPOSE Survivors of childhood, adolescent, and young adult cancer are at risk of late effects, including pulmonary and infectious complications. Whether survivors are at increased risk of COVID-19 infection and severe complications is unknown. METHODS Population-based registries in Ontario, Canada, identified all 5-year survivors of childhood cancer diagnosed age 0-17 years between 1985 and 2014, and of six common adolescent and young adult cancers diagnosed age 15-21 years between 1992 and 2012. Each survivor alive on January 1, 2020, was randomly matched by birth year, sex, and residence to 10 cancer-free population controls. Individuals were linked to population-based laboratory and health care databases to identify COVID-19 tests, vaccinations, infections, and severe outcomes (emergency department [ED] visits, hospitalizations, intensive care unit admissions, and death within 60 days). Demographic, disease, and treatment-related variables were examined as possible predictors of outcomes. RESULTS Twelve thousand four hundred ten survivors were matched to 124,100 controls. Survivors were not at increased risk of receiving a positive COVID-19 test (386 [3.1%] v 3,946 [3.2%]; P = .68) and were more likely to be fully vaccinated (hazard ratio, 1.23; 95 CI, 1.20 to 1.37). No increase in risk among survivors was seen in emergency department visits (adjusted odds ratio, 1.2; 95 CI, 0.9 to 1.6; P = .19) or hospitalization (adjusted odds ratio, 1.8; 95 CI, 1.0 to 3.5; P = .07). No survivor experienced intensive care unit admission or died after COVID-19 infection. Pulmonary radiation or chemotherapies associated with pulmonary toxicity were not associated with increased risk. CONCLUSION Cancer survivors were not at increased risk of COVID-19 infections or severe sequelae. These results can inform risk-counseling of survivors and their caregivers. Further study is warranted to determine risk in older survivors, specific subsets of survivors, and that associated with novel COVID-19 variants.

Evaluating Accuracy of Medical Information Distribution Regarding Risk of COVID-19 Infections and Childhood Cancer Survivors

“…The results from the study by Gupta et al 1 have shown that young cancer survivors do not face a higher risk of COVID-19 disease as compared with the control group, which were established on the basis of demographic and medical characteristics such as age, income, and presence of various medical diagnosis. However, likewise mentioned in this study, a study by Cheung et al 2 concluded higher anxiety levels over COVID-19 disease among childhood cancer survivors and caretakers.…”

“…In a recent study, Gupta et al 1 investigated the risk and severity of COVID-19 disease in young cancer survivors and concluded that young cancer survivors do not face higher risks or more severe complications of COVID-19 disease. We would like to congratulate the authors for this highly comprehensive study.…”

“…In this study, Gupta et al 1 have taken into account medical diagnosis records of both childhood cancer survivors and control groups, including risk factors to COVID-19 such as diabetes and hypertension. However, as seen in Table 1 in the study, 1 there is a two-fold difference between percentage of childhood cancer survivors with diabetes (2.6) compared with percentage of control group with diabetes (1.3). This is supported by findings that suggest specific cancer therapies heighten risk of diabetes mellitus in patients.…”

Increased Risk of Young-Onset Digestive Tract Cancers Among Young Adults Age 20-39 Years With Nonalcoholic Fatty Liver Disease: A Nationwide Cohort Study

“…4 However, the majority of global deaths from young-onset cancers occur in low-and middle-income countries, where the young population has poor access to health care. [4][5][6] Individuals with young-onset cancers have unique challenges and needs before, during, and after treatment, including delayed diagnosis, 7 poor treatment outcomes, 8,9 long-term complications, [10][11][12][13][14][15][16] difficult end-of-life care, 5 and significant loss of potential life. 17 Therefore, global efforts to prevent young-onset digestive tract cancers are urgently needed.…”

Long‐COVID and long‐term cancer survivorship—Shared lessons and opportunities

“…While the risk of poor COVID-19 outcomes among long-term cancer survivors has not been elucidated, the concomitant risk factors due to pre-existing chronic medical conditions related to prior chemotherapy and radiation therapy (e.g., cardiomyopathy, coronary artery disease and pulmonary fibrosis, immunosuppression due to prior bone marrow transplant or splenectomy) are likely to place dual survivors at elevated risk. Interestingly, a recent study of childhood, adolescent and young adult survivors found no increase in risk for COVID-19 and severe complications (Gupta et al, 2022). Identifying and caring for such individuals will likely present further challenges as cancer survivors may also have pre-existing symptoms, such as neuropathy, musculoskeletal deconditioning, among others with resultant functional impairments that put them at higher risk for Long-COVID and related sequelae.…”