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People recently diagnosed with cancer may be at an increased risk of contracting COVID-19 and experiencing worse outcomes than those who have never had a cancer diagnosis. The association was heightened in Black patients.
Patients who have recently been diagnosed with cancer may be at an increased risk of contracting COVID-19, compared to people who have never had a cancer diagnosis.
The study results, which were published in JAMA Oncology, also indicated that the association between a recent cancer diagnosis and risk of contracting COVID-19 was heightened in Black patients.
Previous reports out of the United States and China, according to the study authors, have indicated an increased risk of severe outcomes and death as a result of COVID-19 in patients with cancer, but other information was lacking.
“There is a knowledge gap regarding the susceptibility of patients with cancer to COVID-19 and its severe outcomes in the U.S.,” the study authors wrote. “It remains unknown how race and other demographic factors such as age and sex affect the risk of COVID-19 infection and outcomes among patients with cancer, given that the cancer burden in the U.S. varies by race and other demographic factors.”
The authors conducted a retrospective case-controlled study using data from an electronic health record collection (IBM Watson Health Explorys) that represents 20% of the U.S. population.
At the time this study was conducted (August 2020), the patient population included approximately 73.4 million people (53.64% female), of which, 2,523,920 were diagnosed with at least one of 13 common cancers before or within the last year. Fewer people (273,140) received a cancer diagnosis within the last year. Among the study population, 16,750 patients were diagnosed with COVID-19; 1,200 of them had a cancer diagnosis, of which 690 occurred in the last year.
A recent cancer diagnosis (within the last year) was associated with a significantly increased risk for contractingCOIVD-19. The strongest association of risk occurred in patients recently diagnosed with leukemia, non-Hodgkin lymphoma and lung cancer. Patients with a recent diagnosis of thyroid cancer had the weakest associated risk of contracting COVID-19.
Consistent with previous data, the authors identified that Black patients were at a significantly increased risk for COVID-19, compared to White patients. This racial disparity was seen mostly in patients with breast cancer, prostate cancer, colorectal cancer and lung cancer.
“Owing to limited socioeconomic, behavioral and lifestyle information in the electronic data record database, we are unable to assess how these factors contributed to this profound racial disparity in patients with cancer,” the authors wrote. “The underlying mechanisms for the observed cancer specific race disparity, with the largest disparity seen for breast cancer, remain unclear and warrant further investigation.”
The data showed that patients with cancer and COVID-19 had significantly worse outcomes than those patients with COVD-19 and no cancer. The hospitalization rates were 47.46% for those with cancer and COVID-19 and 24.26% for those without cancer. The death rate for patients with cancer and COVID-19 was 14.93% and 5.26% for those who had COVID-19 but did not have cancer. Black patients were more likely to be hospitalized than White patients, but not more likely to die.
The authors noted there were several limitations to the study, most notably the use of an electronic health record database. The limitation with using electronic health record data when conducting research, according to the authors, is that data is often collected for billing purposes; patients could be underdiagnosed, overdiagnosed or misdiagnosed; as well as limited information on patients including their lifestyle and socioeconomics. They also highlighted that COVID-19 is tested at drive-up and pop-ups, so it is possible that those reported cases might not have been captured in the electronic health record.
“Despite these limitations, this large nationwide database allows us to identify early trends in risks, disparities, and outcomes of COVID-19 in patients with cancer engaged with health care systems on a nationwide basis,” they concluded.
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