COVID ‐19 outcomes in patients with cancer: Findings from the University of California health system database

  1. Daniel H. Kwon
  2. Jose Cadena
  3. Sam Nguyen
  4. Kwan Ho Ryan Chan
  5. Braden Soper
  6. Amy L. Gryshuk
  7. Julian C. Hong
  8. Priyadip Ray
  9. Franklin W. Huang

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Abstract

Background

The interaction between cancer diagnoses and COVID‐19 infection and outcomes is unclear. We leveraged a state‐wide, multi‐institutional database to assess cancer‐related risk factors for poor COVID‐19 outcomes.

Methods

We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at 17 California medical centers. We identified adults tested for SARS‐CoV‐2 from 2/1/2020–12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS‐CoV‐2 test. Secondary outcomes were SARS‐CoV‐2 positivity and severe COVID‐19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer‐related factors associated with outcomes.

Results

We identified 409,462 patients undergoing SARS‐CoV‐2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67–0.74, p  < 0.001). Among the 1781 SARS‐CoV‐2‐positive patients with cancer, BCR/ABL‐negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25–3.41, p  = 0.007), venetoclax (RR 2.96, 95% CI: 1.14–5.66, p  = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10–5.19, p  = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID‐19.

Conclusions

In this large, diverse cohort, cancer was associated with a decreased risk of SARS‐CoV‐2 positivity. Patients with BCR/ABL‐negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS‐CoV‐2 infection. Mechanistic and comparative studies are needed to validate findings.

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  1. Version published to 10.1002/cam4.4604
  2. ScreenIT

    SciScore for 10.1101/2021.09.07.21263244: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: 15 The study protocol was reviewed and approved by both UCSF and Lawrence Livermore National Laboratory institutional review boards.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Antineoplastic systemic therapies were categorized by antibody, chemotherapy, hormone therapy, immune-based therapy, tyrosine kinase inhibitor, other cytotoxic therapy, and other targeted therapy (Supplementary Data S2).
    tyrosine kinase inhibitor, other cytotoxic therapy,
    suggested: None
    Software and Algorithms
    SentencesResources
    14 The logistic regression models were implemented using the statsmodels module in the Python programming language (v3.8).
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations. The database does not contain other risk factors for severe COVID-19, including cancer stage, smoking status, poor performance status, and socioeconomic variables such as insurance status. Similarly, the database did not allow us to discriminate between patients with active versus non-active cancer. There may be selection bias from potential over-representation of patients cared for at academic centers, as well as the inclusion of only patients who underwent SARS-CoV-2 testing. Lastly, we could not ascertain outcomes of patients who sought care outside the UC health system. Conclusion: As the COVID-19 pandemic continues in regions without high levels of vaccination and new, highly transmissible variants develop, it is important to remain vigilant of risk factors for severe infection. Close attention will allow us to better prevent and monitor COVID-19 in high-risk patients. Patients with COVID-19 and myeloproliferative neoplasms, and those receiving methotrexate or venetoclax, may be at an increased risk of poor outcomes. Further studies to confirm these associations are needed, as are studies to understand underlying mechanisms. Further investigation is also needed to explain and confirm the lower risk of test positivity in patients with cancer than those without cancer. Lastly, policy makers and health systems should focus on establishing timely, live central databases of electronic health data to provide rapidly accumulating data for future p...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.09.07.21263244v1 on medRxiv