A new review of data from a large cancer database confirms that Black and Hispanic patients with cancer are more likely to be infected with COVID-19 than White patients. Novel coronavirus infections raging across the country have disrupted the U.S. health care system, including cancer care. Epidemiologic data show that COVID-19 infections have led to poorer outcomes among certain populations, most prominently Black and Hispanic patients.
"Understanding COVID-19 risk factors may help patients and oncologists identify high-risk patients and plan for the best cancer treatment in a timely fashion. Patients with cancer are, unfortunately, faced with balancing cancer treatments with the risk of developing COVID-19," said Robert S. Miller MD, FACP, FASCO, Medical Director for CancerLinQ. "This research, while preliminary, will hopefully help patients and providers understand which ones are most at risk for COVID-19 and plan cancer treatment accordingly."
Miller presented the results of the study based on the findings of more than 477,000 patients with cancer at the 2020 ASCO Quality Care Symposium.
Using data from ASCO's CancerLinQ Discovery database, Miller and colleagues found that Black patients with cancer were almost two times more likely (relative risk 1.69), and Hispanic patients were more than five times more likely (relative risk 5.25) to test positive for COVID-19 compared with White patients. Additionally, patients with hematologic cancers were 1.36 times more likely to be diagnosed with COVID-19 compared to patients with solid tumors. The elevated risk among Black and Hispanic patients with hematologic cancers is noteworthy since they often have compromised immune systems and are already susceptible to many other types of infection, he noted.
About the Study
The researchers examined the records of 477,613 patients with cancer from the beginning of January to the end of August 2020. Patients with a diagnosis of a malignant neoplasm and at least two encounters in the past year at a reporting CancerLinQ practice were defined as the underlying cancer patient population at risk for SARS-CoV-2 infection. COVID-19 cases were identified via a positive RT-PCR test for SARS-CoV-2 RNA and/or an ICD-10 code for coronavirus.
COVID-19 infections were reported at 29 CancerLinQ sites during the study period, and 23 sites reported at least one COVID-19 case. Of 965 COVID-19 cases, a laboratory test identified the virus in 935 cases and 30 cases had an ICD-10 coded diagnosis; 14 cases had both a positive laboratory test and coded diagnosis.
"It's important to emphasize how critically important it is to gather data specifically about patients with cancer during this pandemic," Miller said. "We have to better understand the risks to different populations to identify mitigation strategies. CancerLinQ surveillance is one of the ways that we can gain more information about patients with cancer during the pandemic."
In conclusion, Miller said: "Hispanic or Latino and Black/African-American patients with cancer are at increased risk for COVID-19 disease compared to non-Hispanic and White patients." He noted that patients with hematologic malignancies were at increased risk for COVID-19 disease compared to patients with solid tumors. All-cause mortality was not elevated in these patients, however. As would be expected, older patients (over age 70 years) with COVID-19 infections had a higher mortality than younger ones.
CancerLinQ is a real-world oncology data platform developed by ASCO that collects and aggregates longitudinal electronic health record data from oncology practices throughout the United States. The goal is to rapidly improve patient care and accelerate discovery by securely compiling, harmonizing, analyzing, and de-identifying vast amounts of information on patient characteristics, for example, molecular profiles and comorbidities, treatments, and long-term side effects. By using data from nearly 2 million patients in near real time, CancerLinQ can identify trends and associations between myriad variables, thereby enabling physicians to generate new hypotheses and apply those conclusions to improve care in real-world settings.
Next Steps
The researchers plan to continue analyzing data as this patient population grows. They hope to examine whether other risk factors, such as stage at diagnosis, presence of certain malignancies, and certain types of cancer treatment, may also increase a patient's risk for COVID-19. In addition, they plan to look for more specific risk factors for death related to COVID-19 in patients with cancer in a multivariate manner.
"We plan to refine the mortality analysis to include specific time intervals, for example, 30-day or 60-day mortality, and explore additional outcomes, such as hospitalization and ICU admission," said Miller.
ASCO Expert Sonali M. Smith, MD, Professor of Medicine at the University of Chicago Medicine, commented: "Patients with cancer should not have to make the decision between receiving cancer treatment and avoiding the risk of contracting COVID-19. Health care providers should be aware of this increased risk in Black and Hispanic patients with cancer so that steps can be taken to mitigate the risk of infection."
Mark L. Fuerst is a contributing writer.