Cancer patients who have not received recent cancer treatment have similar COVID-19 outcomes as patients without cancer, after adjusting for potential confounders, according to a study published in JAMA Oncology.
On the other hand, patients who have received recent cancer treatment have a significantly higher risk of hospitalization, ICU stay, and death after developing COVID-19.
Researchers compared outcomes of COVID-19 patients with and without cancer who were included in the Optum COVID-19 electronic health record data set.
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“By including patients diagnosed with COVID-19 between January and December 2020, we were uniquely positioned to evaluate the temporal trends that likely reflect the benefits associated with new therapeutics, detailed treatment guidelines, and increased expertise by clinicians,” the researchers wrote.
Of the 507,307 COVID-19 patients identified, 14,287 (2.8%) also had cancer. The majority (69.9%) of these patients had not received recent anticancer treatment.
Patients with cancer were significantly older and had more comorbidities than the general population (P <.001 for both).
Results
In an unadjusted analysis, cancer patients — regardless of recent treatment — were more likely than non-cancer patients to have adverse outcomes from COVID-19. For instance, the mortality rate was 1.6% for patients without cancer, 5.0% for cancer patients with no recent cancer treatment, and 7.6% for patients with recent cancer treatment.
However, after adjusting for potential confounders, the researchers found that cancer patients with no recent cancer treatment had similar or better outcomes than non-cancer patients.
Cancer patients without recent cancer treatment had a lower risk of mechanical ventilation (odds ratio [OR], 0.61; 95% CI, 0.54-0.68) and hospitalization (OR, 0.79; 95% CI, 0.75-0.83) than patients who did not have cancer. In addition, there were no significant differences in mortality (OR, 0.93; 95% CI, 0.84-1.02) or ICU stay (OR, 0.98; 95% CI, 0.91-1.06) between the 2 groups.
However, patients with recent cancer treatment had a higher risk of death (OR, 1.74; 95% CI, 1.54-1.96), ICU stay (OR, 1.69; 95% CI, 1.54-1.87), and hospitalization (OR, 1.19; 95% CI, 1.11-1.27) compared with non-cancer patients.
In particular, patients with recent chemotherapy or chemoimmunotherapy had a significantly higher risk of death, mechanical ventilation, ICU stay, and hospitalization compared with patients who had no recent cancer treatment (P <.001 for all).
The increased risk of adverse outcomes associated with chemotherapy and chemoimmunotherapy was notable, according to the researchers. They pointed out that the use of immunotherapy, targeted therapy, or endocrine therapy alone were associated with a higher risk of mechanical ventilation but not mortality, ICU stay, or hospitalization.
“The results of this study have risk stratification and resource use implications for the unprecedented challenges currently being experienced by patients, clinicians, and health care systems,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Chavez-MacGregor M, Lei X, Zhao H, Scheet P, Giordano SH. Evaluation of COVID-19 mortality and adverse outcomes in US patients with or without cancer. JAMA Oncol. Published online October 28, 2021. doi:10.1001/jamaoncol.2021.5148
