Abstract S09-01: Cancer and race: Two important risk factors for COVID-19 incidence as captured by the COVID Symptom Study real-time epidemiology tool

Background: The COVID-19 pandemic and response underscore the urgent need for real-time population-level data, especially for vulnerable populations (e.g., cancer patients, racial and ethnic minorities). Smartphone applications (“apps”) facilitate the collection of self-reported data at scale, the results of which can then be rapidly redeployed to inform the public health response. The COVID Symptom Study is an app that was launched March 24, 2020, and is now used by nearly 4 million people in the U.S., U.K., and Sweden.

Methods: COVID Symptom Study app users self-report health status (e.g., symptoms, COVID-19 testing, health care utilization), comorbidities, demographics, and key risk factors for infection on a daily basis. Multivariable adjusted logistic regression models were used to determine the association of cancer and race with COVID-19 prevalence, adjusting for age, sex, comorbidities, and risk factors for infection, from app launch through May 25, 2020.

Results: Among 23,266 individuals with cancer and 1,784,293 without cancer, we documented 155 and 10,249 self-reports of COVID-19, respectively. Compared to individuals without cancer, those with cancer had an increased risk of COVID-19 (adjusted odds ratio (aOR): 1.60; 95% confidence interval (CI): 1.36-1.88). The association was stronger among older participants >65 compared to younger participants (Pinteraction<0.001) and among males (aOR: 1.71; 95%CI: 1.36-2.15) compared to females (aOR: 1.43; 95%CI: 1.14-1.79; Pinteraction=0.02). Chemotherapy/immunotherapy was associated with a 2-fold increased risk of COVID-19 (aOR: 2.22; 95% CI: 1.68-2.94) and risk of COVID-related hospitalization (aOR:2.47; 95% CI: 2.22-2.76). In a separate analysis, we documented 8,990 self-reported cases of positive COVID-19 testing among 2,304,472 non-Hispanic white participants (93.6% of cohort); 93 among 19,498 Hispanic participants; 204 among 19,498 Black participants; 608 among 64,429 Asian participants; and 352 among 65,046 mixed race/other racial minorities. Compared with non-Hispanic white participants, the ORs for reporting a positive COVID-19 test for racial minorities ranged from 1.44 (mixed race/other races) to 2.59 (Black). After accounting for risk factors for infection, comorbidities, and sociodemographic characteristics, the aORs were 1.37 (95% CI 1.09-1.72) for Hispanic participants, 1.42 (95% CI 1.23-1.64) for Black participants, 1.44 (95% CI 1.33-1.57) for Asian participants, and 1.18 (95% CI 1.06-1.32) for mixed race/other minorities.

Conclusion: Our results demonstrate an increase in COVID-19 risk among ethnic minorities and individuals with cancer, particularly those on treatment with chemotherapy/immunotherapy. The association with minorities was not completely explained by other known risk factors for COVID-19 or sociodemographic characteristics. These findings highlight the utility of app-based syndromic surveillance for quantifying the impact of the COVID-19 pandemic on at-risk populations.

Citation Format: David A. Drew, Long H. Nguyen, Wenjie Ma, Chun-Han Lo, Amit D. Joshi, Daniel Sikavi, Christina M. Astley, Karla Lee, Mary Ni Lochlainn, Maria Gomez, Sebastien Ourselin, Andrew T. Chan. Cancer and race: Two important risk factors for COVID-19 incidence as captured by the COVID Symptom Study real-time epidemiology tool [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S09-01.

PD-L1 as a prognostic biomarker in surgically resectable non-small cell lung cancer: a meta-analysis

Background

PD-L1 tumor expression has been associated with poor prognosis in a variety of solid tumors, including lung cancer, and represents a validated target for immune checkpoint inhibition in advanced malignances. It remains unknown, however, if PD-L1 can be used to predict survival in early stage, surgically treated cancers. This meta-analysis compares PD-L1 tumor expression and long term survival after surgical resection in early non-small cell lung cancer (NSCLC).

Methods

PubMed was searched to identify eligible studies that compared survival of surgically resected stage I–III NSCLC patients according to PD-L1 tumor expression. Included studies were grouped according to measurement criteria of PD-L1 expression: 1%, 5%, 50% cutoffs or H-score. Meta-analysis was performed using a linear mixed-effects model to determine overall survival (OS). I² was used as a measure of heterogeneity.

Results

There were 40 eligible studies, including 10,380 patients. Regardless of cut-off used, higher PD-L1 tumor expression was associated with worse OS [hazard ratio (HR)_1%: 1.59, 95% confidence interval (CI), 1.17–2.17; HR_5%: 1.44, 95% CI, 1.03–2.00; HR_50%: 1.52, 95% CI, 1.02–2.25, HR_H-score: 1.34, 95% CI, 1.04–1.73]. Study heterogeneity was low and not statistically significant under all PD-L1 cutoffs.

Conclusions

PD-L1 expression is consistently associated with worse survival, regardless of how it is quantified. In addition to acting as a prognostic biomarker, PD-L1 may also be used in future as a predictive biomarker for patients most likely to benefit from adjuvant immunotherapy.

Association Between Sulfur-Metabolizing Bacterial Communities in Stool and Risk of Distal Colorectal Cancer in Men

BACKGROUND & AIMS

Sulfur-metabolizing microbes, which convert dietary sources of sulfur into genotoxic hydrogen sulfide (H2S), have been associated with development of colorectal cancer (CRC). We identified a dietary pattern associated with sulfur-metabolizing bacteria in stool and then investigated its association with risk of incident CRC using data from a large prospective study of men.

METHODS

We collected data from 51,529 men enrolled in the Health Professionals Follow-up Study since 1986 to determine the association between sulfur-metabolizing bacteria in stool and risk of CRC over 26 years of follow-up. First, in a subcohort of 307 healthy men, we profiled serial stool metagenomes and metatranscriptomes and assessed diet using semiquantitative food frequency questionnaires to identify food groups associated with 43 bacterial species involved in sulfur metabolism. We used these data to develop a sulfur microbial dietary score. We then used Cox proportional hazards modeling to evaluate adherence to this pattern among eligible individuals (n = 48,246) from 1986 through 2012 with risk for incident CRC.

RESULTS

Foods associated with higher sulfur microbial diet scores included increased consumption of processed meats and low-calorie drinks and lower consumption of vegetables and legumes. Increased sulfur microbial diet scores were associated with risk of distal colon and rectal cancers, after adjusting for other risk factors (multivariable relative risk, highest vs lowest quartile, 1.43; 95% confidence interval 1.14-1.81; P-trend = .002). In contrast, sulfur microbial diet scores were not associated with risk of proximal colon cancer (multivariable relative risk 0.86; 95% CI 0.65-1.14; P-trend = .31).

CONCLUSIONS

In an analysis of participants in the Health Professionals Follow-up Study, we found that long-term adherence to a dietary pattern associated with sulfur-metabolizing bacteria in stool was associated with an increased risk of distal CRC. Further studies are needed to determine how sulfur-metabolizing bacteria might contribute to CRC pathogenesis.

The relationship between psychosocial factors in the patient-oncologist relationship and quality of care: A study of breast cancer patients

This study examined the relationship between psychosocial factors in the patient-oncologist relationship and aspects of care among women with breast cancer. Breast cancer patients (N = 118) completed a questionnaire about their relationship with their oncologist, their treatment, and their health. While trust was related to several positive outcomes, physician supportiveness was most strongly related to satisfaction with care, and health care access was most strongly associated with general health. The results suggest that the addition of supportiveness and healthcare access to trust provide a more complete picture of patients' health outcomes.

The impact of Hurricane Sandy on the mental health of New York area residents

OBJECTIVE

To evaluate the long-term psychological impact of Hurricane Sandy on New York residents.

DESIGN

Prospective, cross-sectional study.

SETTING

Community-based study.

PARTICIPANTS

From October 2013 to February 2015, 669 adults in Long Island, Queens, and Staten Island completed a survey on their behavioral and psychological health, demographics, and hurricane impact (ie, exposure).

MAIN OUTCOME MEASURES

Depression, anxiety, and post-traumatic stress disorder (PTSD).

RESULTS

Using multivariable logistic regression models, the relationships between Hurricane Sandy exposure and depression, anxiety, and PTSD were examined. Participants experienced an average of 3.9 exposures to Hurricane Sandy, most of which were related to property damage/loss. Probable depression was reported in 33.4 percent of participants, probable anxiety in 46 percent, and probable PTSD in 21.1 percent. Increased exposure to Hurricane Sandy was significantly associated with a greater likelihood of depression (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), anxiety (OR = 1.08, 95% CI: 1.03-1.13), and probable PTSD (OR = 1.32, 95% CI: 1.23-1.40), even after controlling for demographic factors known to increase susceptibility to mental health issues.

CONCLUSIONS

Individuals affected by Hurricane Sandy reported high levels of mental health issues and were at an increased risk of depression, anxiety, and PTSD in the years following the storm. Recovery and prevention efforts should focus on mental health issues in affected populations.