Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Massachusetts General Hospital, Boston, Massachusetts, USA.
Oncologist. 2021 Aug;26(8):685-693. doi: 10.1002/onco.13794. Epub 2021 May 12.
Early reports suggested increased mortality from COVID-19 in patients with cancer but lacked rigorous comparisons to patients without cancer. We investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death in hospitalized patients with COVID-19.
We identified patients with a history of cancer admitted to two large hospitals between March 13, 2020, and May 10, 2020, with laboratory-confirmed COVID-19 and matched them 1:2 to patients without a history of cancer.
Men made up 56.2% of the population, with a median age of 69 years (range, 30-96). The median time since cancer diagnosis was 35.6 months (range, 0.39-435); 80% had a solid tumor, and 20% had a hematologic malignancy. Among patients with cancer, 27.8% died or entered hospice versus 25.6% among patients without cancer. In multivariable analyses, the odds of death/hospice were similar (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.65-1.82). The odds of intubation (OR, 0.46; 95% CI, 0.28-0.78), shock (OR, 0.54; 95% CI, 0.32-0.91), and intensive care unit admission (OR, 0.51; 95% CI, 0.32-0.81) were lower for patients with a history of cancer versus controls. Patients with active cancer or who had received cancer-directed therapy in the past 6 months had similar odds of death/hospice compared with cancer survivors (univariable OR, 1.31; 95% CI, 0.66-2.60; multivariable OR, 1.47; 95% CI, 0.69-3.16).
Patients with a history of cancer hospitalized for COVID-19 had similar mortality to matched hospitalized patients with COVID-19 without cancer, and a lower risk of complications. In this population, patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared with survivors of cancer.
This study investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death or hospice admission in hospitalized patients with COVID-19. Active cancer, systemic cancer therapy, and a cancer history are not independent risk factors for death from COVID-19 among hospitalized patients, and hospitalized patients without cancer are more likely to have severe COVID-19. These findings provide reassurance to survivors of cancer and patients with cancer as to their relative risk of severe COVID-19, may encourage oncologists to provide standard anticancer therapy in patients at risk of COVID-19, and guide triage in future waves of infection.
早期报告表明，癌症患者 COVID-19 死亡率增加，但缺乏与非癌症患者的严格比较。我们研究了当前癌症诊断或癌症病史是否是 COVID-19 住院患者死亡的独立危险因素。
我们确定了 2020 年 3 月 13 日至 2020 年 5 月 10 日期间在两家大医院住院的有癌症病史的患者，并将其与没有癌症病史的患者按 1:2 匹配。
人群中男性占 56.2%，中位年龄为 69 岁（范围为 30-96 岁）。癌症诊断后中位时间为 35.6 个月（范围为 0.39-435）；80%为实体瘤，20%为血液恶性肿瘤。癌症患者中有 27.8%死亡或进入临终关怀，而非癌症患者中为 25.6%。多变量分析中，死亡/临终关怀的可能性相似（比值比[OR]，1.09；95%置信区间[CI]，0.65-1.82）。与对照组相比，癌症患者插管（OR，0.46；95%CI，0.28-0.78）、休克（OR，0.54；95%CI，0.32-0.91）和入住重症监护病房（OR，0.51；95%CI，0.32-0.81）的可能性较低。与癌症幸存者相比，正在接受癌症治疗或在过去 6 个月内接受过癌症定向治疗的癌症患者死亡/临终关怀的可能性相似（单变量 OR，1.31；95%CI，0.66-2.60；多变量 OR，1.47；95%CI，0.69-3.16）。
因 COVID-19 住院的癌症患者与未患癌症的 COVID-19 住院患者的死亡率相似，并发症风险较低。在该人群中，与癌症幸存者相比，正在接受癌症治疗或近期癌症治疗的癌症患者发生不良结局的风险相似。
本研究旨在探讨当前癌症诊断或癌症病史是否是 COVID-19 住院患者死亡或临终关怀的独立危险因素。活动性癌症、全身癌症治疗和癌症病史不是 COVID-19 住院患者死亡的独立危险因素，而非癌症住院患者更可能出现严重 COVID-19。这些发现为癌症幸存者和癌症患者提供了有关其相对严重 COVID-19 风险的保证，可能鼓励肿瘤学家为有 COVID-19 风险的患者提供标准的抗癌治疗，并指导未来感染浪潮的分诊。
