Evaluation of COVID-19 Mortality and Adverse Outcomes in US Patients With or Without Cancer | Critical Care Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Evaluation of COVID-19 Mortality and Adverse Outcomes in US Patients With or Without Cancer

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the rates of death, mechanical ventilation, intensive care unit stay, and hospitalization among patients with COVID-19 with or without cancer?

Findings  In this cohort study of 507 307 patients with COVID-19, those with cancer who received anticancer treatment within 3 months before COVID-19 diagnosis had an increased risk of death, intensive care unit admission, and hospitalization. Patients without recent cancer treatment had similar or better outcomes than patients without cancer.

Meaning  The results of this study have risk stratification and resource use implications for patients, clinicians, and health care systems.


Importance  As the COVID-19 pandemic continues, understanding the clinical outcomes of patients with cancer and COVID-19 has become critically important.

Objective  To compare the outcomes of patients with or without cancer who were diagnosed with COVID-19 and to identify the factors associated with mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization.

Design, Setting, and Participants  This cohort study obtained data from the Optum de-identified COVID-19 electronic health record data set. More than 500 000 US adults who were diagnosed with COVID-19 from January 1 to December 31, 2020, were analyzed.

Exposures  The patient groups were (1) patients without cancer, (2) patients with no recent cancer treatment, and (3) patients with recent cancer treatment (within 3 months before COVID-19 diagnosis) consisting of radiation therapy or systemic therapy.

Main Outcomes and Measures  Mortality, mechanical ventilation, ICU stay, and hospitalization within 30 days of COVID-19 diagnosis were the main outcomes. Unadjusted rates and adjusted odds ratios (ORs) of adverse outcomes were presented according to exposure group.

Results  A total of 507 307 patients with COVID-19 were identified (mean [SD] age, 48.4 [18.4] years; 281 165 women [55.4%]), of whom 493 020 (97.2%) did not have cancer. Among the 14 287 (2.8%) patients with cancer, 9991 (69.9%) did not receive recent treatment and 4296 (30.1%) received recent treatment. In unadjusted analyses, patients with cancer, regardless of recent treatment received, were more likely to have adverse outcomes compared with patients without cancer (eg, mortality rate: 1.6% for patients without cancer, 5.0% for patients with no recent cancer treatment, and 7.8% for patients with recent cancer treatment). After adjustment, patients with no recent cancer treatment had similar or better outcomes than patients without cancer (eg, mortality OR, 0.93 [95% CI, 0.84-1.02]; mechanical ventilation OR, 0.61 [95% CI, 0.54-0.68]). In contrast, 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) was observed in patients with recent cancer treatment. Compared with patients with nonmetastatic solid tumors, those with metastatic solid tumors and hematologic malignant neoplasms had worse outcomes (eg, mortality OR, 2.36 [95% CI, 1.96-2.84]; mechanical ventilation OR, 0.87 [95% CI, 0.70-1.08]). Recent chemotherapy and chemoimmunotherapy were also associated with worse outcomes (eg, chemotherapy mortality OR, 1.84 [95% CI, 1.51-2.26]).

Conclusions and Relevance  This cohort study found that patients with recent cancer treatment and COVID-19 had a significantly higher risk of adverse outcomes, and patients with no recent cancer treatment had similar outcomes to those without cancer. The findings have risk stratification and resource use implications for patients, clinicians, and health systems.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 18, 2021.

Published Online: October 28, 2021. doi:10.1001/jamaoncol.2021.5148

Corresponding Author: Sharon H. Giordano, MD, MPH, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX 77030 (sgiordan@mdanderson.org).

Author Contributions: Drs Chavez-MacGregor and Giordano had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chavez-MacGregor, Lei, Giordano.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chavez-MacGregor, Lei.

Critical revision of the manuscript for important intellectual content: Lei, Zhao, Scheet, Giordano.

Statistical analysis: Chavez-MacGregor, Lei, Scheet.

Obtained funding: Chavez-MacGregor, Giordano.

Administrative, technical, or material support: Zhao, Giordano.

Supervision: Chavez-MacGregor.

Conflict of Interest Disclosures: Dr Chavez-MacGregor reported serving as a consultant to Pfizer, Roche, and AstraZeneca. No other disclosures were reported.

Funding/Support: This study was supported by cancer center support grant P30CA016672 from the National Cancer Institute of the National Institutes of Health to the University of Texas MD Anderson Cancer Center. Drs Chavez-MacGregor and Giordano were supported by grant SAC150061 from the Susan G. Komen Foundation and RP 160674 from the Cancer Prevention and Research Institute of Texas. Dr Chavez-MacGregor was also supported by Conquer Cancer, the ASCO Foundation, and by the Breast Cancer Research Foundation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

World Health Organization. COVID-19 weekly epidemiological update. Accessed July 15, 2021. https://covid19.who.int
National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. Accessed May 1, 2021. https://www.covid19treatmentguidelines.nih.gov/
Bonow  RO , Fonarow  GC , O’Gara  PT , Yancy  CW .  Association of Coronavirus Disease 2019 (COVID-19) with myocardial injury and mortality.   JAMA Cardiol. 2020;5(7):751-753. doi:10.1001/jamacardio.2020.1105PubMedGoogle ScholarCrossref
Rizzo  S , Chawla  D , Zalocusky  K ,  et al.  Descriptive epidemiology of 16,780 hospitalized COVID-19 patients in the United States.   medRxiv. Preprint posted August 11, 2020. Google Scholar
Golozar  A , Lai  LY , Sena  AG ,  et al.  Baseline phenotype and 30-day outcomes of people tested for COVID-19: an international network cohort including 3.32 million people tested with real-time PCR and 219,000 tested positive for SARS-CoV-2 in South Korea, Spain and the United States.   medRxiv. Preprint posted October 27, 2020. Google Scholar
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; the Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775 PubMedGoogle ScholarCrossref
Wang  Q , Berger  NA , Xu  R .  Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection.   JAMA Oncol. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178 PubMedGoogle ScholarCrossref
de Azambuja  E , Brandão  M , Wildiers  H ,  et al; Belgian Collaborative Group on COVID-19 Hospital Surveillance and the Belgian Society of Medical Oncology (BSMO).  Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis.   ESMO Open. 2020;5(5):e000947. doi:10.1136/esmoopen-2020-000947 PubMedGoogle Scholar
Liang  W , Guan  W , Chen  R ,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6 PubMedGoogle ScholarCrossref
Erdal  GS , Polat  O , Erdem  GU ,  et al.  The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study.   Int J Clin Oncol. 2021;26(5):826-834. doi:10.1007/s10147-021-01863-6 PubMedGoogle ScholarCrossref
Liang  J , Jin  G , Liu  T ,  et al.  Clinical characteristics and risk factors for mortality in cancer patients with COVID-19.   Front Med. 2021;15(2):264-274. doi:10.1007/s11684-021-0845-6 PubMedGoogle ScholarCrossref
Zhang  H , Han  H , He  T ,  et al.  Clinical characteristics and outcomes of COVID-19-infected cancer patients: a systematic review and meta-analysis.   J Natl Cancer Inst. 2021;113(4):371-380. doi:10.1093/jnci/djaa168PubMedGoogle ScholarCrossref
Lièvre  A , Turpin  A , Ray-Coquard  I ,  et al; GCO-002 CACOVID-19 collaborators/investigators.  Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: a French nationwide cohort study (GCO-002 CACOVID-19).   Eur J Cancer. 2020;141:62-81. doi:10.1016/j.ejca.2020.09.035 PubMedGoogle ScholarCrossref
Kuderer  NM , Choueiri  TK , Shah  DP ,  et al; COVID-19 and Cancer Consortium.  Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.   Lancet. 2020;395(10241):1907-1918. doi:10.1016/S0140-6736(20)31187-9 PubMedGoogle ScholarCrossref
Lee  LY , Cazier  JB , Angelis  V ,  et al; UK Coronavirus Monitoring Project Team.  COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study.   Lancet. 2020;395(10241):1919-1926. doi:10.1016/S0140-6736(20)31173-9 PubMedGoogle ScholarCrossref
Grivas  P , Khaki  AR , Wise-Draper  TM ,  et al.  Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium.   Ann Oncol. 2021;32(6):787-800. doi:10.1016/j.annonc.2021.02.024 PubMedGoogle ScholarCrossref
National Cancer Institute. Division of Cancer Control and Population Sciences. Accessed April 29, 2021. https://cancercontrol.cancer.gov/
Bohl  A , Roozeboom-Baker  MA . COVID-19 primer: analyzing health care claims, administrative data, and public use files. Mathematica; 2020. Accessed April 2021. https://www.mathematica.org/publications/a-covid-19-primer-analyzing-health-care-claims-administrative-data-and-public-use-files
Barrett  ML , Smith  MW , Elixhauser  A , Honigman  LS , Pines  JM . Utilization of intensive care services, 2011: Statistical Brief #185. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality; 2006.
Centers for Disease Control and Prevention. Scientific evidence for conditions that increase risk of severe illness. Updated November 2, 2020. Accessed January 4, 2021. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/underlying-evidence-table.html
Deyo  RA , Cherkin  DC , Ciol  MA .  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.   J Clin Epidemiol. 1992;45(6):613-619. doi:10.1016/0895-4356(92)90133-8 PubMedGoogle ScholarCrossref
National Cancer Institute. Targeted cancer therapies. Accessed February 1, 2021. https://www.cancer.gov/cancertopics/factsheet/Therapy/targeted
Garassino  MC , Whisenant  JG , Huang  LC ,  et al; TERAVOLT investigators.  COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study.   Lancet Oncol. 2020;21(7):914-922. doi:10.1016/S1470-2045(20)30314-4 PubMedGoogle ScholarCrossref
Zhang  L , Zhu  F , Xie  L ,  et al.  Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China.   Ann Oncol. 2020;31(7):894-901. doi:10.1016/j.annonc.2020.03.296 PubMedGoogle ScholarCrossref
Newman  LA , Winn  RA , Carethers  JM .  Similarities in risk for COVID-19 and cancer disparities.   Clin Cancer Res. 2021;27(1):24-27. doi:10.1158/1078-0432.CCR-20-3421 PubMedGoogle ScholarCrossref
Tartof  SY , Qian  L , Hong  V ,  et al.  Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization.   Ann Intern Med. 2020;173(10):773-781. doi:10.7326/M20-3742 PubMedGoogle ScholarCrossref
Sharafeldin  N , Bates  B , Song  Q ,  et al.  Outcomes of COVID-19 in patients with cancer: report from the National COVID Cohort Collaborative (N3C).   J Clin Oncol. 2021;39(20):2232-2246. doi:10.1200/JCO.21.01074 PubMedGoogle ScholarCrossref
Rüthrich  MM , Giessen-Jung  C , Borgmann  S ,  et al; LEOSS Study Group.  COVID-19 in cancer patients: clinical characteristics and outcome-an analysis of the LEOSS registry.   Ann Hematol. 2021;100(2):383-393. doi:10.1007/s00277-020-04328-4 PubMedGoogle ScholarCrossref
Miyashita  H , Mikami  T , Chopra  N ,  et al.  Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City.   Ann Oncol. 2020;31(8):1088-1089. doi:10.1016/j.annonc.2020.04.006 PubMedGoogle ScholarCrossref
Liu  H , Yang  D , Chen  X ,  et al.  The effect of anticancer treatment on cancer patients with COVID-19: A systematic review and meta-analysis.   Cancer Med. 2021;10(3):1043-1056. doi:10.1002/cam4.3692PubMedGoogle ScholarCrossref
Jee  J , Foote  MB , Lumish  M ,  et al.  Chemotherapy and COVID-19 outcomes in patients with cancer.   J Clin Oncol. 2020;38(30):3538-3546. doi:10.1200/JCO.20.01307 PubMedGoogle ScholarCrossref
García-Suárez  J , de la Cruz  J , Cedillo  Á ,  et al; Asociación Madrileña de Hematología y Hemoterapia (AMHH).  Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study.   J Hematol Oncol. 2020;13(1):133. doi:10.1186/s13045-020-00970-7 PubMedGoogle ScholarCrossref
Lee  LYW , Cazier  JB , Starkey  T ,  et al; UK Coronavirus Cancer Monitoring Project Team.  COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study.   Lancet Oncol. 2020;21(10):1309-1316. doi:10.1016/S1470-2045(20)30442-3 PubMedGoogle ScholarCrossref
Desai  A , Khaki  AR , Kuderer  NM .  Use of real-world electronic health records to estimate risk, risk factors, and disparities for COVID-19 in patients with cancer.   JAMA Oncol. 2021;7(2):227-229. doi:10.1001/jamaoncol.2020.5461 PubMedGoogle ScholarCrossref
Desai  A , Gupta  R , Advani  S ,  et al.  Mortality in hospitalized patients with cancer and coronavirus disease 2019: a systematic review and meta-analysis of cohort studies.   Cancer. 2021;127(9):1459-1468. doi:10.1002/cncr.33386 PubMedGoogle ScholarCrossref
Kalinsky  K , Accordino  MK , Hosi  K ,  et al.  Characteristics and outcomes of patients with breast cancer diagnosed with SARS-Cov-2 infection at an academic center in New York City.   Breast Cancer Res Treat. 2020;182(1):239-242. doi:10.1007/s10549-020-05667-6 PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity



My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right