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

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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.

Abstract

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.

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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.

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