Prevalence and Outcome of COVID-19 Infection in Cancer Patients: A National Veterans Affairs Study

• Published in: JNCI : Journal of the National Cancer Institute Vol. 113; no. 6; pp. 691 - 698
• Main Authors: Fillmore, Nathanael R, La, Jennifer, Szalat, Raphael E, Tuck, David P, Nguyen, Vinh, Yildirim, Cenk, Do, Nhan V, Brophy, Mary T, Munshi, Nikhil C
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-06-2021; Oxford Publishing Limited (England)
• Subjects: Cancer; Comorbidity; Coronaviruses; COVID-19; COVID-19 - epidemiology; Demographics; Demography; Electronic health records; Electronic medical records; Health care; Health risks; Health services; Humans; Immunotherapy; Infections; Malignancy; Mortality; Neoplasms - complications; Patients; Prevalence; Risk analysis; Risk Factors; Smoking; Solid tumors; Statistical analysis; Statistical tests; Tumors; United States; United States Department of Veterans Affairs; Viral diseases; United States
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djaa159

Abstract
Background
Emerging data suggest variability in susceptibility and outcome to coronavirus disease 2019 (COVID-19) infection. Identifying risk factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations.
Methods
We analyzed electronic health records of the US Veterans Affairs Healthcare System and assessed the prevalence of COVID-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for COVID-19 who were positive, as well as outcome attributable to COVID-19, and stratified by clinical characteristics including demographics, comorbidities, cancer treatment, and cancer type. All statistical tests are 2-sided.
Results
Of 22 914 cancer patients tested for COVID-19, 1794 (7.8%) were positive. The prevalence of COVID-19 was similar across age. Higher prevalence was observed in African American (15.0%) compared with White (5.5%; P < .001) and in patients with hematologic malignancy compared with those with solid tumors (10.9% vs 7.8%; P < .001). Conversely, prevalence was lower in current smokers and patients who recently received cancer therapy (<6 months). The COVID-19–attributable mortality was 10.9%. Higher attributable mortality rates were observed in older patients, those with higher Charlson comorbidity score, and in certain cancer types. Recent (<6 months) or past treatment did not influence attributable mortality. Importantly, African American patients had 3.5-fold higher COVID-19–attributable hospitalization; however, they had similar attributable mortality as White patients.
Conclusion
Preexistence of cancer affects both susceptibility to COVID-19 infection and eventual outcome. The overall COVID-19–attributable mortality in cancer patients is affected by age, comorbidity, and specific cancer types; however, race or recent treatment including immunotherapy do not impact outcome.