COVID-19 outcomes in patients with cancer: Findings from the University of California health system database

Daniel H Kwon; Jose Cadena; Sam Nguyen; Kwan Ho Ryan Chan; Braden Soper; Amy L Gryshuk; Julian C Hong; Priyadip Ray; Franklin W Huang

doi:10.1002/cam4.4604

COVID-19 outcomes in patients with cancer: Findings from the University of California health system database

Cancer Med. 2022 Jun;11(11):2204-2215. doi: 10.1002/cam4.4604. Epub 2022 Mar 9.

Authors

Daniel H Kwon¹, Jose Cadena², Sam Nguyen², Kwan Ho Ryan Chan^{2

3}, Braden Soper⁴, Amy L Gryshuk⁵, Julian C Hong^{6

7

8}, Priyadip Ray², Franklin W Huang^{1

6

7}

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, California, USA.
² Computational Engineering, Engineering Directorate, Lawrence Livermore National Laboratory, California, USA.
³ Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Center for Applied Scientific Computing, Computing Directorate, Lawrence Livermore National Laboratory, California, USA.
⁵ Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, California, USA.
⁶ Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA.
⁷ Bakar Computational Health Sciences Institute, University of California San Francisco, California, USA.
⁸ Department of Radiation Oncology, University of California San Francisco, California, USA.

Abstract

Background: The interaction between cancer diagnoses and COVID-19 infection and outcomes is unclear. We leveraged a state-wide, multi-institutional database to assess cancer-related risk factors for poor COVID-19 outcomes.

Methods: We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at 17 California medical centers. We identified adults tested for SARS-CoV-2 from 2/1/2020-12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS-CoV-2 test. Secondary outcomes were SARS-CoV-2 positivity and severe COVID-19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer-related factors associated with outcomes.

Results: We identified 409,462 patients undergoing SARS-CoV-2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67-0.74, p < 0.001). Among the 1781 SARS-CoV-2-positive patients with cancer, BCR/ABL-negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25-3.41, p = 0.007), venetoclax (RR 2.96, 95% CI: 1.14-5.66, p = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10-5.19, p = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID-19.

Conclusions: In this large, diverse cohort, cancer was associated with a decreased risk of SARS-CoV-2 positivity. Patients with BCR/ABL-negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS-CoV-2 infection. Mechanistic and comparative studies are needed to validate findings.

Keywords: COVID-19; cancer; myeloproliferative neoplasm; outcomes research.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
COVID-19 Testing
COVID-19* / epidemiology
Hospitalization
Humans
Methotrexate
Neoplasms* / epidemiology
Retrospective Studies
SARS-CoV-2

Substances

Methotrexate