Risk of adverse outcomes from COVID-19 is higher for patients with cancer

1. COVID-19 patients with cancer had increased rates of hospitalization, ICU stay, and mortality than patients without cancer.

2. Patients with hematologic malignant neoplasms and metastatic solid tumours had worse outcomes than those with nonmetastatic solid tumours.

Evidence Rating Level: 2 (Good)

Study Rundown: The severity of infection with COVID-19 has been found to be worse in patients with cancer. This study details the outcomes of COVID-19 on hospital admission, ICU stay, mechanical ventilation, and mortality in patients with recently treated cancer, cancer with no recent treatment, or no cancer. Additionally it reports on tumour types associated with a more severe course of COVID-19 infection. Hospitalization rates were 33.7% for patients with recently treated cancer, 25.2% for cancer without recent treatment, and 14.6% for patients without cancer. The rate of ICU stay was 12.3%, 7.7%, and 3.3%, respectively. As well, mechanical ventilation rates were 6.8%, 3.7%, and 2.2%. Mortality was highest in patients who had been recently treated with chemotherapy for cancer at 7.8%. The rates were lower in patients with cancer that hadn’t been recently treated with chemotherapy (5.0%) and patients without cancer (1.6%). Cancer patients with hematologic malignant neoplasms and metastatic solid tumours had a worse prognosis than those with nonmetastatic solid tumours. Some limitations to this study include potential underestimation of the mortality rate and potential ascertainment bias from using the electronics health records database. Uninsured patients may not be represented in the study patient populations and so care must be taken when applying the results to that group. Overall, patients infected with COVID-19 and who have cancer fare worse than those who do not have cancer, and patients who were recently treated for their cancer do worse than those who have not received treatment in the previous 3 months.

Click to read the study in JAMA Oncology

Relevant Reading: Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection

In-Depth [retrospective cohort]: This cohort study was conducted via the electronic medical records database, Optum, and included data from hospitals and clinics across the United States. 507,307 patients were included in the analysis; 14,287 patients had cancer and 493,020 did not have cancer. Of the patients with cancer, 4,296 had cancer treatment within the previous 3 months, while 9,991 did not. Eligibility for inclusion in this study were adult patients who had COVID-19. Patients were grouped into those with and those without cancer. Further division of the cancer group included those who had recent cancer treatment (within 3 months) and those who did not. Hospital admission rates were highest for cancer patients with recent treatment as compared to those without cancer (Odds ratio (OR), 1.19; 95% confidence interval (CI), 1.11-1.27). Patients with recently treated cancer also had a higher risk than patients without cancer to stay in the ICU (OR, 1.69; 95% CI, 1.54-1.87) or death (OR, 1.74; 95% CI, 1.54-1.96). Patients who had cancer but had not received recent treatment had lower risk of hospitalization than patients without cancer (OR, 0.79; 95% CI, 0.75-0.83) and also had a lower risk of mechanical ventilation (OR, 0.61; 95% CI, 0.54-0.68). ICU admission and mortality did not differ significantly between the two previous groups (OR, 0.98; 95%, 0.91-1.06 and OR, 0.93, 95% CI, 0.84-1.02, respectively). Both hospitalization and mortality were increased in patients who had metastatic solid tumours as compared to those with nonmetastatic solid tumours (OR, 1.37; 95% CI, 1.24-1.52; OR, 2.36; 95% CI, 1.96-2.84, respectively). Outcomes were similar for patients with hematologic malignant neoplasms (OR, 1.44; 95% CI, 1.30-1.59 for hospitalization, and OR, 1.72; 95% CI, 1.42-2.08, for mortality).

Image: PD

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