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Nolan MB, Piasecki TM, Smith SS, Baker TB, Fiore MC, Adsit RT, Bolt DM, Conner KL, Bernstein SL, Eng OD, Lazuk D, Gonzalez A, Hayes-Birchler T, Jorenby DE, D'Angelo H, Kirsch JA, Williams BS, Kent S, Kim H, Lubanski SA, Yu M, Suk Y, Cai Y, Kashyap N, Mathew J, McMahan G, Rolland B, Tindle HA, Warren GW, Abu-el-rub N, An LC, Boyd AD, Brunzell DH, Carrillo VA, Chen LS, Davis JM, Deshmukh VG, Dilip D, Goldstein AO, Ha PK, Iturrate E, Jose T, Khanna N, King A, Klass E, Lui M, Mermelstein RJ, Poon C, Tong E, Wilson KM, Theobald WE, Slutske WS. Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin. Cancer Epidemiol Biomarkers Prev 2023; 32:12-21. [PMID: 35965473 PMCID: PMC9827105 DOI: 10.1158/1055-9965.epi-22-0500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is mixed evidence about the relations of current versus past cancer with severe COVID-19 outcomes and how they vary by patient and cancer characteristics. METHODS Electronic health record data of 104,590 adult hospitalized patients with COVID-19 were obtained from 21 United States health systems from February 2020 through September 2021. In-hospital mortality and ICU admission were predicted from current and past cancer diagnoses. Moderation by patient characteristics, vaccination status, cancer type, and year of the pandemic was examined. RESULTS 6.8% of the patients had current (n = 7,141) and 6.5% had past (n = 6,749) cancer diagnoses. Current cancer predicted both severe outcomes but past cancer did not; adjusted odds ratios (aOR) for mortality were 1.58 [95% confidence interval (CI), 1.46-1.70] and 1.04 (95% CI, 0.96-1.13), respectively. Mortality rates decreased over the pandemic but the incremental risk of current cancer persisted, with the increment being larger among younger vs. older patients. Prior COVID-19 vaccination reduced mortality generally and among those with current cancer (aOR, 0.69; 95% CI, 0.53-0.90). CONCLUSIONS Current cancer, especially among younger patients, posed a substantially increased risk for death and ICU admission among patients with COVID-19; prior COVID-19 vaccination mitigated the risk associated with current cancer. Past history of cancer was not associated with higher risks for severe COVID-19 outcomes for most cancer types. IMPACT This study clarifies the characteristics that modify the risk associated with cancer on severe COVID-19 outcomes across the first 20 months of the COVID-19 pandemic. See related commentary by Egan et al., p. 3.
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Affiliation(s)
- Margaret B. Nolan
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas M. Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert T. Adsit
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel M. Bolt
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karen L. Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Steven L. Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Oliver D. Eng
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Lazuk
- Yale-New Haven Health System, New Haven, Connecticut
| | - Alec Gonzalez
- BlueTree Network, a Tegria Company, Madison, Wisconsin
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Heather D'Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Julie A. Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Brian S. Williams
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sean Kent
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Youmi Suk
- School of Data Science, University of Virginia, Charlottesville, Virginia
| | - Yuxin Cai
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nitu Kashyap
- Yale-New Haven Health System, New Haven, Connecticut
- Yale School of Medicine, New Haven, Connecticut
| | - Jomol Mathew
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gabriel McMahan
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Betsy Rolland
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Noor Abu-el-rub
- Center for Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, Kansas City, Kansas
| | - Lawrence C. An
- Division of General Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Andrew D. Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | | | - Victor A. Carrillo
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey
| | - Li-Shiun Chen
- Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - James M. Davis
- Duke Cancer Institute and Duke University Department of Medicine, Durham, North Carolina
| | | | - Deepika Dilip
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam O. Goldstein
- Department of Family Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Patrick K. Ha
- Division of Head and Neck Surgical Oncology, University of California San Francisco, San Francisco, California
| | | | - Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Niharika Khanna
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Elizabeth Klass
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle Lui
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robin J. Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Chester Poon
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisa Tong
- Department of Internal Medicine, University of California Davis, Davis, California
| | - Karen M. Wilson
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Wendy E. Theobald
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Corresponding Author: Wendy S. Slutske, UW Center for Tobacco Research and Intervention, 1930 Monroe Street #200, Madison, WI 53711. Phone: 608-262-8673; E-mail:
| | - Wendy S. Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Corresponding Author: Wendy S. Slutske, UW Center for Tobacco Research and Intervention, 1930 Monroe Street #200, Madison, WI 53711. Phone: 608-262-8673; E-mail:
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