Cancer Patients at High Risk of Death From COVID-19 Identified

By Marilynn Larkin

June 18, 2021

NEW YORK (Reuters Health) - Using real-world data, researchers identified characteristics of cancer patients at highest risk of mortality from COVID-19.

"We set out to take advantage of the largest clinical cohort of patients with COVID-19, assembled by the National COVID Cohort Collaborative (N3C), to build the cancer cohort and identify what puts patients at highest risk of death from COVID-19," Dr. Noha Sharafeldin of the School of Medicine, University of Alabama at Birmingham told Reuters Health by email.

"Using real-world data from across the (U.S.), we found about 16% of patients to be COVID-19 positive," she said. "Infection with COVID-19 increased the hazard of mortality by 20%."

"Older individuals, males, having a higher number of other comorbid conditions, and patients with hematological malignancies had higher mortality," she noted. "We observed a higher risk of mortality in patients on active cytotoxic treatment, but not with immunotherapies or targeted therapies."

As reported in the Journal of Clinical Oncology and presented in part at the ASCO 2021 Virtual Meeting, Dr. Sharafeldin and colleagues constructed a cohort using data from more than four million patients from 50 US medical centers in the N3C.

Analyses were restricted to those with a COVID-19-positive or COVID-19-negative diagnosis between January 1, 2020 - March 25, 2021.

The team identified close to 400,000 patients with cancer (mean age, 65; about half women; 62% non-Hispanic white), of whom 15.9% were COVID-19-positive. The most common cancers were skin (13.8%), breast (13.7%), prostate (10.6%), hematologic (10.5%), and GI cancers (10%).

COVID-19 positivity was significantly associated with an increased risk of all-cause mortality (hazard ratio, 1.20).

Among COVID-19-positive individuals, specific factors associated with the increased risk included: being 65 or older, male gender, Southern or Western US residence, an adjusted Charlson Comorbidity Index score 4 or more, hematologic malignancy, multitumor sites, and recent cytotoxic therapy.

Notably, those who received recent immunotherapies or targeted therapies were not at higher risk.

The authors conclude, "Full characterization of the cohort will provide further insights into the effects of COVID-19 on cancer outcomes and the ability to continue specific cancer treatments."

Dr. Sharafeldin added, "Using real-world data is not without many challenges, yet efforts to improve data extraction and harmonization tools makes electronic health record data a valuable resource to study effects of disease and potentially inform clinical management."

"It is expected that certain environmental factors, including access to care and spread of the virus, may influence outcomes," she said. "However, from our cohort and other international cohorts, similar demographic and clinical factors emerge that put patients at higher risk including age, gender and existing comorbidities."

Dr. Michael Grossbard, Section chief, Hematology, at the Perlmutter Cancer Center at NYU Langone Health in New York City commented in an email to Reuters Health, "The results are clinically important. Patients with cancer, and particularly those with hematologic malignancies, are at high risk of complications and death from COVID-19 infection."

"Some of these same patients may be the least able to mount an immune response to the COVID-19 vaccines," he said. "As such, cancer patients in high-risk categories will continue to take appropriate precautions with masking and social distancing until the pandemic abates."

"I believe these findings will be generalizable to the rest of the world," he said, "especially for those patients receiving chemotherapy and rituximab-based therapy."

"I would like to see data on the immune response of cancer patients to the covid-19 vaccines," Dr. Grossbard concluded.

SOURCE: Journal of Clinical Oncology, online June 4, 2021