Compared to people who have not been diagnosed with cancer, people who have been diagnosed with cancer have a higher risk of being infected with COVID-19 and having more severe complications if they are infected, according to a large study.
These risks were higher for people recently diagnosed with cancer (within a year). The risks were also higher for Black people, especially Black people recently diagnosed with breast cancer.
While it’s been known that people with active cancer have a higher risk of serious complications if they are infected with COVID-19, this is some of the first research showing that people diagnosed with cancer have a higher risk of being infected with COVID. The study also suggests that people with a history of cancer may have a higher risk of COVID infection, but to a lesser degree than people with a recent cancer diagnosis.
The research was published in the Feb. 2021 issue of JAMA Oncology. Read the abstract of “Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection.”
About the study
To do the study, researchers from Case Western Reserve University looked at the records of 73.4 million people from 360 hospitals and 317,000 doctors’ offices in the United States from 1999 to Aug. 14, 2020.
Of the people in the study:
- 2,523,920 were diagnosed with at least one of 13 common types of cancer; 273,140 of the cancer diagnoses happened within the last year; the researchers considered these recent diagnoses
- 16,570 were diagnosed with COVID-19
- 1,200 were diagnosed with both COVID-19 and cancer
- 53.64% were female
- 45.67% were male
- 59.88% were between the ages of 18 and 65
- 24.42% were older than 65
- 54.74% were white
- 10.33% were Black
- 1.62% were Asian
- 1.44% were Hispanic/Latino
- 12.29% were of unknown ethnicity
- 35.16% had private insurance
- 10.39% were on Medicare
- 8.33% were on Medicaid
- 6.67% self-paid for their medical care
Of the cancer diagnoses:
- 663,250 were breast cancers; 70,580 were recent
- 487,560 were prostate cancers; 61,010 were recent
- 419,050 were lung cancers; 34,830 were recent
- 317,580 were colorectal cancers; 25,150 were recent
- 198,890 were melanomas (skin cancer); 11,490 were recent
- 193,140 were liver cancers; 15,070 were recent
- 168,750 were non-Hodgkin lymphomas (cancer of the lymph system); 26,460 were recent
- 138,890 were bladder cancers; 14,300 were recent
- 137,890 were leukemias (cancer of the blood-forming tissues, such as bone marrow); 16,930 were recent
- 124,170 were kidney cancers; 12,810 were recent
- 109,870 were thyroid cancers; 14,140 were recent
- 70,950 were pancreatic cancers; 5,280 were recent
- 41,740 were endometrial cancers; 7,750 were recent
Of the 1,200 people diagnosed with COVID-19 and cancer, 690 people had a recent diagnosis of at least one of the 13 common cancers listed above:
- 180 were recent breast cancer diagnoses
- 140 were recent prostate cancer diagnoses
- 100 were recent lung cancer diagnoses
- 90 were recent non-Hodgkin lymphoma diagnoses
- 80 were recent leukemia diagnoses
- 60 were recent colorectal cancer diagnoses
- 40 were recent liver cancer diagnoses
- 30 were recent bladder cancer diagnoses
- 30 were recent kidney cancer diagnoses
- 20 were recent melanoma diagnoses
- 20 were recent endometrial cancer diagnoses
- 20 were recent pancreatic cancer diagnoses
- 20 were recent thyroid cancer diagnoses
How a cancer diagnosis affects the risk of COVID infection
The researchers analyzed the risk of COVID-19 infection for someone diagnosed with one of the 13 types of cancer, taking into account age, race, sex, and other factors that could possibly increase a person’s risk of being infected with COVID-19, including:
- heart disease
- type 2 diabetes
- chronic kidney diseases
- chronic obstructive pulmonary disease (difficulty breathing)
- being treated with chemotherapy, radiation therapy, or immunotherapy
- having a transplant surgery
- being in a nursing home or care facility
The analysis showed that people diagnosed with cancer had a higher risk of being infected with COVID-19 compared to people who were not diagnosed with cancer:
- People diagnosed with cancer were about 1.46 times more likely to be diagnosed with COVID-19.
- People recently diagnosed with cancer were about 7 times more likely to be diagnosed with COVID-19.
The researchers then looked to see if the type of recently diagnosed cancer affected the increase in risk of being diagnosed with COVID-19. They found that people diagnosed with certain cancers were more likely to be diagnosed with COVID-19:
- people with leukemia were more than 12 times more likely
- people with non-Hodgkin lymphoma were more than 8 times more likely
- people with lung cancer were more than 7 times more likely
- people with liver cancer were more than 6 times more likely
- people with pancreatic cancer were more than 6 times more likely
- people with endometrial cancer were more than 4 times more likely
- people with thyroid cancer were more than 3 times more likely
The researchers then looked to see how a person’s age, sex, and race affected the risk of COVID-19 infection in people with a recent diagnosis of six of the most common cancers:
- non-Hodgkin lymphoma
The researchers took into account other common conditions that can affect the risk of COVID-19 infection, such as high blood pressure and diabetes, as well as cancer treatments, any transplant procedures, and time spent in a care facility.
The results showed that Black people with a recent diagnosis of one of the six cancers above were more likely to be infected with COVID-19 than white people. The largest difference was in Black people with a recent diagnosis of breast cancer. Compared to white people with the same recent cancer diagnoses, Black people were more likely to be diagnosed with COVID-19:
- Black people with breast cancer were 5.4 times more likely
- Black people with prostate cancer were 5.1 times more likely
- Black people with colorectal cancer were 3.3 times more likely
- Black people with lung cancer were 2.5 times more likely
- Black people with leukemia were 1.6 times more likely
Women with a recent diagnosis of colorectal cancer and non-Hodgkin lymphoma had a higher risk of COVID-19 infection than men recently diagnosed with these two types of cancer.
How a cancer diagnosis affects outcomes
The researchers then looked at outcomes — specifically, hospitalization and death.
Of the 15,510 adults and seniors (age 18 and older) diagnosed with COVID-19 in the study, 25.27% were hospitalized because of COVID. Overall, 5.61% of these people died.
Of the 670 adults and seniors with a recent cancer diagnosis and a COVID-19 diagnosis, 320 (47.76%) people were hospitalized. Blacks were more likely to be hospitalized than whites:
- 150 of 270 Black people (55.56%) with COVID and a recent cancer diagnosis were hospitalized
- 160 of 370 white people (43.24%) with COVID and a recent cancer diagnosis were hospitalized
Overall, 14.93% of these people died.
Of the 14,840 adults and seniors diagnosed with COVID-19 but not cancer, 3,600 (24.26%) were hospitalized. In this group, Black people were again more likely to be hospitalized than white people. Overall, 5.25% of these people died.
The researchers were not able to determine the cause of death for the people in the study, so it’s unclear if the people died from COVID-19, cancer, or something else.
“In this case-control study, patients with cancer were at significantly increased risk for COVID-19 infection and worse outcomes, which was further exacerbated among African Americans. These findings highlight the need to protect and monitor patients with cancer as part of the strategy to control the pandemic,” the researchers wrote. “This study identified high-risk groups of patients with cancer based on demographic groups and cancer types that are most vulnerable to COVID-19.”
What this means for you
While the results of this study are troubling, they do help identify people who have the highest risk of being infected with COVID-19.
If you were diagnosed in the last year with one of the 13 most common cancers studied in this research, the results suggest you are about 7 times more likely to be infected with COVID-19 than someone who hasn’t been diagnosed with cancer.
If you are Black and have been diagnosed with breast cancer within the last year, this study strongly suggests that you are 5 times more likely to be diagnosed with COVID-19 than someone who is white with a recent breast cancer diagnosis.
Overall, people with a history of cancer were about 1.46 times more likely to be diagnosed with COVID-19 than people who have never been diagnosed with cancer.
Knowing you have a higher risk of being infected with COVID-19 can help you stay vigilant about your safety and avoid becoming casual about following COVID recommendations. It’s extremely important that you:
- practice social distancing
- wear a face mask when you go out of the house
- wash your hands frequently and use hand sanitizer when you can’t wash your hands
- avoid crowds and poorly ventilated spaces
- clean and disinfect surfaces you touch frequently, including doorknobs, light switches, phones, keyboards, handles, and faucets
- be alert for any COVID-19 symptoms, including loss of smell or taste, as well as fever, cough, and shortness of breath
- talk to your doctor about being vaccinated against COVID-19, and get a vaccine as soon as you can if it’s recommended for you
For more information, visit the Breastcancer.org Coronavirus (COVID-19): What People With Breast Cancer Need to Know page.
To talk with others about COVID-19 and breast cancer, join the Breastcancer.org Discussion Board forum All things COVID-19 or coronavirus.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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