NEW YORK (Reuters Health) - Rates of mechanical ventilation, intensive-care unit (ICU) admission or death did not differ significantly among patients with cancer and COVID-19 across different regions of the United States between March and November 2020, according to data from the COVID-19 and Cancer Consortium (CCC19) registry.
However, patients from less densely populated areas had significantly better outcomes compared with patients in more densely populated areas.
Dr. Jessica E. Hawley of the University of Washington/Fred Hutchinson Cancer Research Center in Seattle and colleagues analyzed data on a diverse group of 4,749 patients with cancer and COVID-19 receiving care at 83 centers in the Northeast, Midwest, South and West. Their median age was 66 years, 51% were women, 23% non-Hispanic Black and 15% Hispanic individuals.
After adjusting for patient characteristics, estimated 30-day death rates ranged from 5.2% to 26.6% across centers.
Patients from metropolitan areas with population less than 250,000 had lower odds of dying at 30 days compared with peers from metro areas with population at least one million (adjusted odds ratio, 0.31; 95% CI, 0.11 to 0.84).
The type of center was not significantly associated with 30-day all-cause mortality (the primary outcome) or mechanical ventilation, ICU care and all-cause death (secondary outcomes).
There were no statistically significant differences in outcome rates across nine census divisions, but adjusted mortality rates significantly improved over time (from September to November vs. March to May).
"Understanding whether patient outcomes vary by region is important, as it may guide further resource allocation, assistance, and vaccination efforts," the researchers write in JAMA Network Open.
"It is particularly important for patients with cancer who are at high risk of major complications due to COVID-19, as such understanding may assist oncologic societies, cancer center leadership and administration, and clinical oncology health care authorities formulate effective measures and outreach to combat the ongoing pandemic," they write.
"These findings can inform future collaborative efforts across cancer care delivery centers to monitor outcomes on a per-center basis and collect site-specific information, such as number of positive cases, surrogates for resource strain, and change rate in cancer screening," they add.
"Additionally, comparing guidelines and best practices for treatment of patients with cancer and COVID-19 and exploring socioeconomic and health determinants that may be unique to patients with cancer and COVID-19 may reveal mechanisms for the observed heterogeneity," they say.
SOURCE: https://bit.ly/3zmB1gx JAMA Network Open, online January 4, 2022.
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