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

  1. Nathanael R Fillmore
  2. Jennifer La
  3. Raphael E Szalat
  4. David P Tuck
  5. Vinh Nguyen
  6. Cenk Yildirim
  7. Nhan V Do
  8. Mary T Brophy
  9. Nikhil C Munshi

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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.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.21.20177923: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, the veteran population is primarily male and hence the study represents various trends and associations whose interpretations are restricted to male. Second, patients tested outside the VA system would not be included in this analysis. However, this number is likely to be very small as most patients who get cancer care in the VA do return for their healthcare needs to the VA. Third, it is possible that analyses are confounded by indication for testing. However, we believe that our comparison of those who tested positive to those who tested negative remains relevant, especially because Covid-19 testing criteria at VA hospitals was informed by centralized guidance from the VA Central Office, increasing consistency of testing criteria nationally.27 In conclusion, the presence of cancer changes the susceptibility to Covid-19 infection and affects overall outcome. The overall disease behavior is modulated by patient-related as well as cancer-related factors which needs to be considered in development of Covid-19 preventative strategies as well as modulation of cancer therapies to optimize the patient care. Importantly, having equal access to care is an important component to improving overall outcome.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1093/jnci/djaa159
  3. Version published to 10.1101/2020.08.21.20177923 on medRxiv