Black, low-income patients with cancer at highest risk for severe COVID-19 complications
Patients with cancer demonstrated increased risk for severe COVID-19 complications and mortality, according to study results published in Cancer Reports.
Black race and low-income status appeared associated with highest risk for these outcomes.
“Patients with a history of cancer and those undergoing active treatment for malignancies who contract COVID-19 are susceptible to poor outcomes. Additionally, quicker progression to severe events has been found among patients with cancer vs. those without cancer,” Thomas D. Brown, MD, MBA, oncologist in Seattle and chief medical officer at Syapse, told Healio. “Yet, in the United States, data characterizing COVID-19 in patients with cancer were still quite limited and generally obtained within single health systems or from voluntary surveillance registries or surveys. To that end, the impact of race, health status and socioeconomic factors on COVID-19-related incidence or outcomes in patients with cancer was not well-described.”
Investigators compared clinical, demographic and socioeconomic characteristics of patients with cancer with and without COVID-19 and then characterized the clinical outcomes of patients with COVID-19 and cancer.
They used real-world data from two health systems in the Midwestern United States to identify 146,702 adults (median age, 67 years; 57% women; 68% white) diagnosed with cancer between 2015 and 2020 who did not have COVID-19 and 1,267 adults (median age, 66 years; 57% women; 44% white) with cancer and COVID-19. All-cause mortality served as the primary outcome.
According to study results, patients with cancer who had COVID-19 were more likely to be Black, have active cancer and comorbidities and/or reside in ZIP codes with median household income less than $30,000.
Researchers additionally found higher rates of all-cause mortality (14% vs. 2%), hospital admission (64% vs. 14%) and invasive respiratory support (11% vs. 1%) among patients with cancer and COVID-19 vs. those without COVID-19.
Among patients with COVID-19, those with active cancer appeared more likely than those with a history of cancer to be male (48% vs. 35%) or have a Charlson comorbidity index of 1 or greater (79% vs. 51%).
Moreover, patients were more likely to be diagnosed with COVID-19 by ICD codes alone if they resided in areas with median household income less than $30,000 (62% vs. 49%).
Mortality, hospital admission and use of respiratory support were highest among those with COVID-19 and active cancer or those residing in ZIP codes with median household income less than $30,000.
Black patients with COVID-19 and cancer were most likely to receive invasive respiratory support. They also were more likely than other patients to be hospitalized for pneumonia, cough, respiratory failure, acute renal failure, and fluid and electrolyte disorders, and they also were more likely to receive hydroxychloroquine.
Multivariable logistic regression models showed associations of male sex, older age, living in areas with a median household income less than $30,000, having a history of pulmonary circulation disorders, and recent use of immune checkpoint inhibitors or chemotherapy with higher odds of all-cause mortality.
“Real-world data can be rapidly leveraged to understand urgent health care challenges,” Brown said. “We will be working to further understand the impact of COVID-19 on the delivery of cancer care, as well as on ultimate cancer treatment outcomes in patients with cancer and COVID-19. It will be important to evaluate the long-term effects of COVID-19 within this population. We would also like to assess the vaccination status in our population of patients with cancer, or with a history of cancer, and how this impacts clinical outcomes.”
For more information:
Thomas D. Brown, MD, can be reached at 3410 Cascadia Ave. South, Seattle, WA 98144; email: firstname.lastname@example.org.