Patients with a history of cancer and comorbid cardiovascular (CV) disease were more likely to develop severe COVID-19 compared with either condition alone, according to the results of a retrospective study published in the Journal of the National Comprehensive Cancer Network.1

Previous studies indicated that a history of cancer or CV disease were independently associated with developing severe COVID-19. The aim of this study was to evaluate the risk of severe COVID-19 among patients with a history of cancer comorbid with CV disease.

The retrospective study included 2476 patients with a history of cancer who tested positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) between March and May 2020. The definition of cancer included invasive solid or hematologic malignancies. CV disease included coronary artery disease, cardiomyopathy, congestive heart failure, moderate to severe valvular heart disease, or ischemic stroke.

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The coprimary endpoints were severe COVID-19 disease — which was defined as a composite of the need for mechanical ventilation, shock, or death — in either patients with a history of cancer only, or in patients with a history of cancer and CV disease.

In the cohort, 7.9% of patients had a history of cancer, 16.7% had a history of CV disease, and 3.3% had a history of both cancer and CV disease. The most common cancer types included those of the breast and prostate. Of the patients with cancer, 24.6% had active disease or recent anticancer treatment at the time of SARS-CoV-2 infection or within the prior 6 months.

Among the patients who received anticancer treatment within 6 months prior to SARS-CoV-2 infection, therapies included hormonal therapy, anthracyclines, HER2-targeted agents, and regional radiation therapy. Tyrosine kinase inhibitors and immune checkpoint inhibitors were used in 2.6% and 1% of patients, respectively.

Overall, 11% of patients with COVID-19 developed severe disease over a median of 22 days. History of cancer was an independent predictor of severe COVID-19, as well as advanced age, male sex, smoking, diabetes, and use of beta-blockers. CV disease was not a risk factor.

Patients with a history of cancer were at an increased risk of developing severe COVID-19 compared with patients without a history of cancer (hazard ratio [HR], 2.02; 95% CI, 1.53-2.68; P <.001).

Patients with a history of cancer were also more likely to experience adverse outcomes associated with COVID-19, including hospitalization, shock, arrhythmia, venous thromboembolism, encephalopathy, and death. The median length of hospital stay was also longer among patients with cancer at 5 days compared with 3 days among patients without cancer (P <.001).

Patients with both a history of cancer and CV disease were more likely to develop severe COVID-19 compared with patients with cancer alone (HR, 1.86; 95% CI, 1.11-3.10; P =.02) or CV disease alone (HR, 1.79; 95% CI, 1.21-2.66; P =.004).

Among patients with both cancer and CV disease, death occurred more frequently at 35% compared with 17% of patients with cancer alone (P =.004) or 21% of patients with CV disease alone (P =.009). Arrythmias and encephalopathy were also more common among patients with cancer and comorbid CV disease compared with patients with either condition alone.

The authors concluded that “patients with a history of cancer, particularly those with comorbid CV disease, are at a significantly higher risk of COVID-19–associated adverse outcomes.” They added that “these patients may need to be prioritized as a high-risk group.”

Disclosure: Dr Nohria disclosed that she has received grant/research support from Amgen, is a scientific advisor for Takeda Oncology, and has received consulting fees from AstraZeneca.


Ganatra S, Dani SS, Redd R, et al. Outcomes of COVID-19 in patients with a history of cancer and comorbid cardiovascular disease. J Natl Compr Canc Netw. Epub 2020 Nov 3.