COVID-19 hospitalization among cancer (n = 12,995) and non-cancer patients (n = 34,693) who tested positive and had non-missing covariates. The results were from the model logit P(YHospitalization = 1|X, Cancer, Covariate) = β0 + βXX + βCancerCancerStatus + βIntX × CancerStatus + βCovCovariate, where Covariate = Age + Race/Ethnicity + Sex + Disadvantage Index (quartile) + Comorbidity Score. Reference groups were age: 18 to 35, sex: female, BMI: 18.5 to 25, race: white/non-Hispanic, smoking status: never. A unit change in the continuous age variable is 10 years. The comorbidity score ranges from 0 to 6 and is the sum of indicators for presence of six categories of preexisting conditions in the electronic health record.
Funding
National Science Foundation (NSF)
National Cancer Institute (NCI)
United States Department of Health and Human Services
Find out more...Los Alamos National Laboratory (LANL)
Michigan Institute for Data Science, University of Michigan (MIDAS)
Rogel Cancer Center, University of Michigan (Rogel Cancer Center)
ARTICLE ABSTRACT
Studies have shown an increased risk of severe SARS-CoV-2–related (COVID-19) disease outcome and mortality for patients with cancer, but it is not well understood whether associations vary by cancer site, cancer treatment, and vaccination status.
Using electronic health record data from an academic medical center, we identified a retrospective cohort of 260,757 individuals tested for or diagnosed with COVID-19 from March 10, 2020, to August 1, 2022. Of these, 52,019 tested positive for COVID-19 of whom 13,752 had a cancer diagnosis. We conducted Firth-corrected logistic regression to assess the association between cancer status, site, treatment, vaccination, and four COVID-19 outcomes: hospitalization, intensive care unit admission, mortality, and a composite “severe COVID” outcome.
Cancer diagnosis was significantly associated with higher rates of severe COVID, hospitalization, and mortality. These associations were driven by patients whose most recent initial cancer diagnosis was within the past 3 years. Chemotherapy receipt, colorectal cancer, hematologic malignancies, kidney cancer, and lung cancer were significantly associated with higher rates of worse COVID-19 outcomes. Vaccinations were significantly associated with lower rates of worse COVID-19 outcomes regardless of cancer status.
Patients with colorectal cancer, hematologic malignancies, kidney cancer, or lung cancer or who receive chemotherapy for treatment should be cautious because of their increased risk of worse COVID-19 outcomes, even after vaccination.
Additional COVID-19 precautions are warranted for people with certain cancer types and treatments. Significant benefit from vaccination is noted for both cancer and cancer-free patients.
