Comparison and impact of COVID-19 for patients with cancer: a survival analysis of fatality rate controlling for age, sex and cancer type

Abstract

ObjectivesPrior research has reported an increased risk of fatality for patients with cancer, but most studies investigated the risk by comparing cancer to non-cancer patients among COVID-19 infections, where cancer might have contributed to the increased risk. This study is to understand COVID-19’s imposed HR of fatality while controlling for covariates, such as age, sex, metastasis status and cancer type.MethodsWe conducted survival analyses of 4606 cancer patients with COVID-19 test results from 16 March to 11 October 2020 in UK Biobank and estimated the overall HR of fatality with and without COVID-19 infection. We also examined the HRs of 13 specific cancer types with at least 100 patients using a stratified analysis.ResultsCOVID-19 resulted in an overall HR of 7.76 (95% CI 5.78 to 10.40, p<10−10) by following 4606 patients with cancer for 21 days after the tests. The HR varied among cancer type, with over a 10-fold increase in fatality rate (false discovery rate ≤0.02) for melanoma, haematological malignancies, uterine cancer and kidney cancer. Although COVID-19 imposed a higher risk for localised versus distant metastasis cancers, those of distant metastases yielded higher overall fatality rates due to their multiplicative effects.DiscussionThe results confirmed prior reports for the increased risk of fatality for patients with COVID-19 plus hematological malignancies and demonstrated similar findings of COVID-19 on melanoma, uterine, and kidney cancers.ConclusionThe results highlight the heightened risk that COVID-19 imposes on localised and haematological cancer patients and the necessity to vaccinate uninfected patients with cancer promptly, particularly for the cancer types most influenced by COVID-19. Results also suggest the importance of timely care for patients with localised cancer, whether they are infected by COVID-19 or not.

Prognostic factors in cancer patients infected with SARS-CoV-2: a Latin American country results

“…It is worth stressing that, out of the full cohort, 342 patients presented severe COVID-19 (according to the pre-established definition), 28 where over two-thirds of the patients required hospitalization. We observed that the mortality for this specific subgroup was 31.9%, similar to the results reported by Desai et al 29 25 Cancer is a heterogeneous disease, where besides the treatment type, primary tumor subtype, stage, age, and gender also play a role. 30 Another limitation is that the presented results on cancer patients with COVID-19 in Mexico cannot be generalized to the whole Mexican population due to most of the data coming from the National Cancer Institute, which is one of the largest oncology centers of the country.…”

“…27 The same behavior was noted with hematologic versus solid tumors: univariate analysis detected that the frequency of death in hematologic tumors was higher (p = 0.020). However, after the multivariate analysis, the difference did not withhold its significance and the odds of death were not increased unlike other studies 9,19,21,25 maybe as a consequence of the high rate of hematological patients on surveillance (34.3%). On the contrary, subjective symptoms such as vomiting, nausea, and abdominal pain could be attributed not only to the oncological treatment and the cancer itself but also to COVID-19, and despite we are unable to identify the cause, we found that nausea increased the odds of death.…”

“…Some reports have shown that women with breast cancer have fewer severe forms of COVID-19 and less likely to die. 25,26 Regarding the oncologic treatment, when performing the step-by-step regression, it was detected that receiving treatment increased the odds of death. However, this effect was diluted upon inclusion on the multivariate analysis and variable adjustment.…”

“…In the last months, we have learned that not all cancer patients have risk for fatality among COVID-19 infection. 25 Cancer is a heterogeneous disease, where besides the treatment type, primary tumor subtype, stage, age, and gender also play a role. 30 Another limitation is that the presented results on cancer patients with COVID-19 in Mexico cannot be generalized to the whole Mexican population due to most of the data coming from the National Cancer Institute, which is one of the largest oncology centers of the country.…”

COVID-19 Presentation and Outcomes among Cancer Patients: A Matched Case-Control Study

“…The COVID-19 pandemic has dramatically impacted cancer patients for several reasons, including the difficulty for cancer patients to maintain full access to the healthcare system [ 10 ]. Very early at the start of the pandemic, cancer patients have been pointed out as a population at higher risk of infection by SARS-CoV-2 [ 2 , 11 ], and at higher risk of severe infection and death from COVID-19 [ 5 , 11 , 12 , 13 ].…”