Emerging data suggest variability in susceptibility and outcome to COVID-19 infection. Identifying risk-factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations.
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 two-sided.
Of 22914 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 (AA) (15.0%) compared to White (5.5%; P<.001) and in patients with hematologic malignancy compared to 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, AA patients had 3.5-fold higher COVID-19 attributable hospitalization, however had similar attributable mortality as White patients.
Pre-existence 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 does not impact outcome.