Patients with a recent cancer diagnosis were the most vulnerable at-risk group for Covid-19 infection

Patients with cancer were at significantly greater risk of being infected with Covid-19 than those without cancer, and the differences was exacerbated among Black patients, a retrospective, case-control analysis found.

Among 73.4 million patients included in the electronic health record analysis, approximately 2.5 million had a diagnosis of at least one of 13 common cancers and 273,140 had a diagnosis of cancer within the last year, as detailed by QuanQiu Wang, MS, Case Western Reserve University, Cleveland, and colleagues in JAMA Oncology. Out of this cohort, 16,570 patients had been diagnosed with Covid-19, among whom 1,200 had a cancer diagnosis and 650 patients had a recent cancer diagnosis within the past year.

Patients with any one of 13 cancer types were at increased risk for Covid-19 infection, but those with a recent cancer diagnosis were over 7-fold more likely to contract Covid-19 (adjusted Odds Ratio [aOR] 7.14 [95% CI, 6.91-7.39; P<0.001]) compared to those who did not have cancer—and, among those with a recent diagnosis, Black patients were at significantly higher risk than white patients.

“Based on this analysis of a nationwide EHR database in the U.S., we found that patients with recently diagnosed cancer, particularly leukemia, lung cancer, and [non-Hodgkin’s lymphoma] NHL, had significantly increased risk of Covid-19,” Wang and colleagues reported. “Compared with White patients with cancer, African American patients with cancer had significantly higher risk of Covid-19. Cancer and Covid-19 had synergistic effects on patient outcome as measured by rates of hospitalization and death.”

“[I]t is important to closely monitor patients with cancer and protect them from exposure to severe acute respiratory syndrome coronavirus 2 and the severe outcomes of Covid-19,” they added.

IBM Watson Health Explorys

Data was collected by the IBM Watson Health Explorys from 360 hospitals across 50 states in the US.

“First we examined how cancer was associated with the risk of Covid-19, adjusted for age, sex, race, comorbidities, cancer treatments, transplant procedures, and nursing home stay,” Wang and colleagues explained.

They also looked at how demographic factors affected the risk of infection among those with cancer.

“Patients with cancer had a significantly increased risk for Covid-19 infection compared with patients without cancer, with the stronger effect for recent cancer (aOR 7.14 [95% CI, 6.91-7.39; P<0.001]) than all cancer diagnosis (aOR, 1.46 [95% CI, 1.42-1.50; P<0.001]),” the authors reported.

This finding suggests that patients with active cancer are the most vulnerable group for Covid-19 infection among those with a history of cancer, they added. Even after adjusting for common comorbidities, cancer treatments, transplant procedures, and nursing home stay, “patients with cancer still had a high risk for Covid-19 infection for all 13 cancer types,” they wrote.

The strongest association between Covid-19 infection and cancer was seen for patients with recent diagnosis of leukemia (aOR of 12.16 [95% CI, 11.03-13.40; P<0.001]), non-Hodgkin’s lymphoma (aOR of 8.54 [95% CI, 7.80-9.36; P<0.001]), and lung cancer (aOR of 7.66 [95% CI, 7.07-8.29; P<0.001]).

However, the risk of Covid-19 infection was still significantly higher for those with liver cancer (aOR of 6.49 [95% CI, 5.71-7.38; P<0.001]), pancreatic cancer (aOR of 6.26 [95% CI, 4.98-7.87; P<0.001]), endometrial cancer (aOR of 4.70 [95% CI, 3.79-5.82; P<0.001]), and thyroid cancer (aOR of 3.10 [95% CI, 2.47-3.87]), the authors noted.

After adjusting for age, sex, and Covid-19 risk factors, Black patients were more likely to be infected by Covid-19 than white patients, the largest racial disparity being seen for breast cancer (aOR of 5.44 [95% CI, 4.69-6.31; P<0.001]), prostate cancer (aOR of 5.10 [95% CI, 4.34-5.98; P<0.001]) colorectal cancer (aOR of 3.30 [95% CI, 2.55-4.26; P<0.001]), and lung cancer (aOR of 2.53 [95% CI, 2.10-3.06; P<0.001]).

Interestingly, women with colorectal cancer had a higher risk of contracting Covid-19 than men (aOR of 1.81 [95% CI, 1.41-2.33; P<0.001]), as well as women with non-Hodgkin’s lymphoma (aOR of 1.80 [95% CI, 1.46-2.22; P<0.001]).

In contrast to all other previous reports, age in general had no association with the risk of contracting Covid-19, the authors noted. Hospitalization and death rates were also much higher in adult and senior patients with cancer and Covid-19. For example, the overall hospitalization rate for patients infected with Covid-19 with a recent cancer diagnosis was 47.7% — and hospitalization rates for Black patients were still higher (55.5%) compared to mortality rates for white patients (43.2%; P=0.003).

This compares to hospitalization rates of 24.6% in adult and seniors infected with Covid-19 but without cancer, although rates are again significantly higher among Black patients. Death rates among adults and seniors with Covid-19 and cancer were also higher at 14.9% compared with 5.61% for adults and seniors with Covid-19 but no cancer.

The authors speculated that cancer patients may be at high risk for Covid-19 infection because of their frequent contact with health care workers, although cancer itself likely had a direct effect on a patient’s risk to contract Covid-19 infection.

Social Determinants

In a commentary accompanying the study, Nicole Kuderer, MD, Advanced Cancer Research Group, Kirkland, Washington; Aakash Desai, MBBS, MPH, of the Mayo Clinic in Rochester, Minnesota; and Ali Raza Khaki, MD, of the University of Washington in Seattle suggested that the greater risk for Black patients with cancer to develop Covid-19 relative to white cancer patients could be largely explained by social determinants, including an increased burden of comorbidities, crowded living conditions, dependence on public transportation or child care, and higher risk of viral exposure at work. “Until societal disparities are accounted for, we cannot presume these findings are caused by any inherent differences among racial groups,” they stressed.

The editorialists also pointed out that occupational exposure may partly account for the observed sex differences between women and men at risk for Covid-19 infection, at least among women with colorectal cancer and non-Hodgkin’s lymphoma.

However, Kuderer and colleagues pointed out that the study is limited by the retrospective nature of the case-controlled study, as well as the limited information available from EHR data. They also felt that the percentage of patients with Covid-19 in the EHR database was “surprisingly low” at only 0.3% of all patients included in the analysis, a reflection perhaps as yet-unrecognized limitations for Covid-19-related EHR data.

Kuderer, Desai, and Khaki commended Wang and colleagues on their study for furthering the understanding of the risk factors for Covid-19 and its complications among cancer patients.

“It is becoming quite clear that the solutions for disparities observed with Covid-19 relate primarily to public policy,” they wrote. “Needed solutions require (1) large-scale, high-quality epidemiologic data; (2) policies that mitigate socioeconomic risk factors as well as health care access disparities; and (3) validated risk prediction tools to identify patients at greatest risk from Covid-19 and its complications. Clearly, the haunting spotlight of Covid-19 has dramatically illuminated known US health care and societal disparities. This situation should be a wake-up call that brings much-needed improvements in US equity policies, including but not limited to better health care access. Nothing appears more critical for alleviating these disparate clinical outcomes in this time of crisis and beyond.”

  1. Patients with cancer were at significantly greater risk of contracting Covid-19 than those without cancer, researchers found.
  2. Patients with a recent cancer diagnosis within the past year were the most vulnerable risk group among cancer patients for Covid-19 infection, and this difference was exacerbated among Black patients.

Pam Harrison, Contributing Writer, BreakingMED™

This study was supported by the National Institutes of Health.

The study authors had no conflicts of interest to disclose.

Kuderer reported receiving research consultant fees from G1 Therapeutics, Inc., Invitae Corporation, Beyond Spring, Inc., Spectrum Pharmaceuticals, Inc., Bristol Myers Squibb, Janssen Pharmaceuticals, and Total Health.

 

Cat ID: 118

Topic ID: 78,118,118,935,190,926,192,927,151,928,925,934