Patients with cancer were found to have a significantly higher risk for coronavirus disease 2019 (COVID-19) infection and its adverse outcomes, especially in African American patients, according to findings from a case-control analysis published in JAMA Oncology (2020 Dec 10. Epub ahead of print).

This study “can serve as a baseline study of initial COVID-19 risk, racial disparity, and outcomes observations in patients with cancer across the US,” the reseachers wrote.

To determine the risk of a COVID-19 infection for 13 common cancer types and the adverse reactions, researchers evaluated the electronic health record (EHR) data of 73,449,510 million patients from 360 hospitals and 317,000 clinicians across 50 US states.

Of the total cohort, 2,523,920 patients were diagnosed with at least 1 of the 13 common cancers within or before the last year, and 273,140 patients were recently diagnosed with cancer within the last year. Among 16,570 patients diagnosed with COVID-19, a total of 1200 had a cancer diagnosis and 690 had a recent cancer diagnosis.

Patients who had a cancer diagnosis within the last year were found to have a significantly higher risk for COVID-19 infection (adjusted odds ratio [aOR], 7.14; 95% CI, 6.91-7.39; P <.001) compared with patients without cancer, with the strongest effect seen in patients with recently diagnosed leukemia (aOR, 12.16; 95% CI, 11.03-13.40; P <.001), non-Hodgkin lymphoma (aOR, 8.54; 95% CI, 7.80-9.36; P <.001), and lung cancer (aOR, 7.66; 95% CI, 7.07-8.29; P <.001). The weakest associations were reported in patients with thyroid cancer (aOR, 3.10; 95% CI, 2.47-3.87; P <.001).

Additionally, among patients who were diagnosed with cancer within the last year, African Americans had a significantly higher risk for COVID-19 infection when compared to White patients.

“This finding is consistent with data showing that COVID-19 affects African American individuals at a disproportionately high rate,” the investigators stated.

“Our study showed similar racial disparity for COVID-19 infection before and after controlling for COVID-19 risk factors, suggesting that other factors, such as social adversity, economic status, access to health care, and lifestyle, may have contributed to this profound racial disparity," they continued.

This racial disparity was reported the largest for breast cancer (aOR, 5.44; 95% CI, 4.69-6.31; P <.001), prostate cancer, (aOR, 5.10; 95% CI, 4.34-5.98; P <.001), colorectal cancer (aOR, 3.30; 95% CI, 2.55-4.26; P <.001), and lung cancer (aOR, 2.53; 95% CI, 2.10-3.06; P <.001), respectively.

Overall, patients with cancer and COVID-19 experienced significantly worse outcomes (hospitalization, 47.46%; death, 14.93%) than patients with COVID-19 without cancer (hospitalization, 24.26%; death, 5.26%) (P <.001) and patients with cancer without COVID-19 (hospitalization, 12.39%; death, 4.03%; P <.001).

The investigators suggested that based on the findings, it’s important to closely monitor patients with cancer and protect them from exposure to COVID-19 and its severe outcomes.—Emily Bader