Oncologist. 2021 Apr 15. doi: 10.1002/onco.13794. Online ahead of print.
BACKGROUND: Early reports suggested increased mortality from COVID-19 in patients with cancer but lacked rigorous comparisons to non-cancer patients. We investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death in hospitalized COVID-19 patients.
PATIENTS AND METHODS: We identified patients with a history of cancer admitted to 2 large hospitals between 3/13/2020 and 5/10/2020 with laboratory-confirmed COVID-19 and matched them 1:2 to patients without a history of cancer.
RESULTS: 56.2% of the population was male, with a median age of 69 years (range: 30-96). The median time since cancer diagnosis was 35.6 months (range 0.39-435); 80% had a solid tumor and 20% had a hematologic malignancy. Among patients with cancer, 27.8% died or entered hospice vs. 25.6% among patients without cancer. In multivariable analyses, the odds of death/hospice were similar (OR: 1.09, 95%CI: 0.65-1.82). The odds of intubation (OR: 0.46, 95%CI: 0.28-0.78), shock (OR: 0.54, 95%CI: 0.32-0.91), and intensive care unit admission (OR: 0.51, 95%CI: 0.32-0.81) were lower for patients with a history of cancer vs. controls. Patients with active cancer or who had received cancer-directed therapy in the past 6 months had similar odds of death/hospice compared to cancer survivors (univariable OR: 1.31, 95%CI: 0.66-2.60; multivariable OR: 1.47, 95%CI: 0.69-3.16).
CONCLUSIONS: Patients with a history of cancer hospitalized for COVID-19 had similar mortality to matched hospitalized COVID-19-positive patients without cancer, and a lower risk of complications. In this population, patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared to cancer survivors.
IMPLICATIONS FOR PRACTICE: An understanding of the comorbidities and patient characteristics that portend a severe outcome from COVID-19 can improve patient care and guide the utilization of scare resources. To develop this understanding, we investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death or hospice admission in hospitalized COVID-19 patients. We found that active cancer, systemic cancer therapy, and a history of cancer are not independent risk factors for death from COVID-19 among hospitalized patients, and hospitalized patients without cancer are more likely to have severe COVID-19 marked by intubation, ICU admission, ARDS, and shock. These findings provide reassurance to cancer survivors and patients as to their relative risk of severe COVID-19, may encourage oncologists to provide standard anti-cancer therapy in patients at risk of COVID-19, and guide triage in future waves of infection.