US patients with lung cancer have a higher burden of death from COVID-19 than the general population, and this has been the case since the omicron variant became dominant, according to findings presented at the 2023 World Conference on Lung Cancer.
Data showed that lung cancer patients had a “markedly greater burden” of death from COVID-19 than the general population from January 2022 through the last time point studied in March 2023.
This increased mortality burden coincided with the predominance of the BA.1 variant and the broad lifting of COVID-19 restrictions, such as mask mandates, according to study presenter Priyanka Senthil, of Massachusetts General Hospital in Boston.
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Data Analysis
For this study, Senthil and colleagues examined data on COVID-19 deaths in lung cancer patients and the general US population between March 1, 2020, and March 31, 2023, using the US Centers for Disease Control and Prevention’s WONDER database.
The researchers calculated a COVID-19 mortality ratio by dividing the number of COVID-19 deaths in lung cancer patients in a given month by the number of COVID-19 deaths in the total US population that month.
The researchers also calculated a normalized COVID-19 mortality ratio by dividing the COVID-19 mortality ratio in a given month by the average COVID-19 mortality ratio during the initial wave of the pandemic (March 2020-June 2020). A normalized COVID-19 mortality ratio higher than 1 suggests a higher burden of COVID-19 death in the lung cancer population relative to the general population, when compared to the initial wave of the pandemic. A ratio of 1 indicates a similar burden, and a ratio below 1 indicates a lower burden.
The researchers also analyzed data from Biobot Analytics on the concentration of SARS-CoV-2 in wastewater. The team calculated a normalized SARS-CoV-2 wastewater concentration by dividing the SARS-CoV-2 concentration in a given month by the average monthly SARS-CoV-2 concentration during the initial wave of the pandemic.
Results: Increasing Mortality Burden
The researchers found a similar COVID-19 mortality burden between lung cancer patients and the general population from March 2020 through February 2021, a period when COVID-19 prevention measures were largely still in place and wastewater concentrations of SARS-CoV-2 were relatively low. The normalized COVID-19 mortality ratio was about 1 during this time.
From March 2021 through November 2021, when COVID-19 restrictions began to be lifted, wastewater concentrations of SARS-CoV-2 began to increase. However, the normalized COVID-19 mortality ratio remained around 1 during this time.
Beginning in January 2022, when COVID-19 restrictions had largely been lifted across the country and the BA.1 omicron variant became dominant, COVID-19 cases began to rise. There was a more than 13-fold increase in the normalized wastewater concentration of SARS-CoV-2.
“Shortly after this spike, the COVID-19 mortality ratio increased from 1 to approximately 4, indicating a markedly greater burden of COVID-19 mortality among lung cancer patients relative to the general US population, when compared to the initial wave of the pandemic,” Senthil said.
“Even after the omicron spike, wastewater concentrations of COVID-19 remained significantly elevated when compared to previous months of the pandemic,” she added. “The COVID-19 mortality ratio also remained elevated, suggesting a greater burden of COVID-19 mortality among lung cancer patients vs the general population.”
Senthil noted that the number of lung cancer patients who died from COVID-19 is likely an underestimate, as patients would not be included in this study if their cancer history was not recorded on their death certificate.
“[L]ung cancer patients experienced an increased burden of COVID-19 mortality compared to the general US population during periods in which SARS-CoV-2 was widely circulating in the US, despite high rates of vaccination and access to pre-exposure prophylaxis and antivirals,” Senthil said. “These findings highlight the continued importance of developing strategies to prevent and treat COVID-19 for patients with lung cancer.”
Disclosures: Senthil has no relevant disclosures.
Reference
Senthil P, Potter A, Haridas C, et al. The disparate burden of COVID-19 lung cancer patients during periods of high transmission of SARS-CoV-2. Presented at WCLC 2023. September 9-12, 2023. Abstract MA10.08.
