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

  1. Haiquan Li
  2. Edwin Baldwin
  3. Xiang Zhang
  4. Colleen Kenost
  5. Wenting Luo
  6. Elizabeth A Calhoun
  7. Lingling An
  8. Charles L Bennett
  9. Yves A Lussier

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Abstract

Prior 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.

Methods

We 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.

Results

COVID-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.

Discussion

The 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.

Conclusion

The 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.

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  1. Version published to 10.1136/bmjhci-2021-100341
  2. ScreenIT

    SciScore for 10.1101/2021.02.06.21251099: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationWe also built a randomized non-cancer cohort of 4,606 patients for comparative studies, which matched the COVID-19 status, sex, age (per 5-year bin), and specific laboratory testing facility of the corresponding cancer patients.
    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:
    Limitations include the unavailability of cancer stage and grade plus a relatively small sample size for some specific cancer types. Further, the study was unable to include other preexisting conditions that may have been associated with the fatality, and the conclusions may be limited to symptomatic patients and hospitalized patients due to the inclusion criteria. Our findings reinforce the clinical importance of timely treatment of COVID-19 among older cancer patients with hematological malignancies, melanoma, uterine, or kidney cancer. The findings also support specific guidelines emphasizing the importance of timely care for COVID-19 infected persons and strongly support a change in COVID-19 vaccine strategy with hematologic malignancies in particular.

    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 scite Reference Check: We found no unreliable references.

    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.

  3. Version published to 10.1101/2021.02.06.21251099v1 on medRxiv