A large series from Veneto region of people molecularly tested for SARS-CoV-2 between 22 February and 1 April 2020, point out that a prevalence of cancer was not associated with a risk of infection. However, the proportion of SARS-CoV-2 positive people hospitalised was higher among patients with cancer, as well as the proportion of deaths. The Italian researchers who published their findings in a brief communication on 31 July 2020 in the Nature Cancer, concluded that the risk of adverse outcomes of SARS-CoV-2 infection was significantly higher in patients with cancer versus those without cancer, particularly in case of males, older people and those whose cancer has been diagnosed no more than 2 years before infection.
In their report, the authors addressed the prevalence of patients with a clinical history of cancer in a population tested for SARS-CoV-2 infection among the residents of the Veneto region in the northeast of Italy. The primary outcomes of the study were a quantification of the prevalence of patients with a history of cancer in the population tested for SARS-CoV-2 infection and an estimation of the association between a history of cancer and clinical outcomes of patients who were SARS-CoV-2 positive.
Of the 84,246 individuals tested, 4,789 (5.7%) had a history of cancer. The proportion was higher for males 7.0% (2,311/33,183) than for females 4.9% (2,478/51,063). When the individuals tested for SARS-CoV-2 infection were stratified by age (under 70 years old, 70–79 years old, 80 or more years old), the prevalence of SARS-CoV-2 positive patients with cancer was 10.7% (281/2,628), 18.1% (186/1,025) and 22.5% (256/1,136), respectively, in the three age categories (test for trend p < 0.0001).
By using logistic regression analysis, the prevalence odds ratio (pOR) of a SARS-CoV-2 positive status in the study population was statistically associated with sex (female versus male, pOR 0.68) and age (70–79 versus 0–69 years, pOR 2.73, ≥80 years versus 0–69 years, pOR 3.15). A clinical history of cancer was not associated with SARS-CoV-2 positive status (pOR 0.97).
Among SARS-CoV-2 positive individuals, 7.8% had been diagnosed with cancer. Males prevailed (p = 0.0025) among these patients with cancer, and their distribution increased with older age (test for trend p < 0.0001).
Among the SARS-CoV-2 positive individuals who needed to be hospitalised, a statistically significant difference between the patients with cancer and the others emerged only for age (test for trend p < 0.0001).
Among the 723 SARS-CoV-2 positive patients with cancer, 7.6% had a history of multiple malignancies (38 males and 17 women); 35 of these 55 patients (63.6%) were hospitalised due to their SARS-CoV-2 infection and 8 of 55 (14.5%) died.
The proportion of SARS-CoV-2 positive individuals hospitalised was 56.6% (409/723) among patients with cancer, as compared with 34.4% (2,941/8,552) among the others (p < 0.0001). The prevalence of those admitted to the intensive care unit (ICU) due to COVID-19 did not differ between the patients with cancer and the others. Of the 723 SARS-CoV-2 positive patients with cancer, 106 died of COVID-19 during the study period (14.7%), as compared with 385 of 8,552 (4.5%) of the other SARS-CoV-2 positive individuals (p < 0.0001).
By using logistic regression (pOR adjusted for sex and age), the risk of hospitalisation and death was consistently lower among females. Compared to younger people, SARS-CoV-2 positive patients aged 70 years or more were at greater risk of hospitalisation (pOR 4.02) and death (pOR 25.43).
Individuals who had been diagnosed with cancer within the 2 years before the infection showed the highest risk of both hospitalisation and death (pOR 2.67). No statistically significant association emerged between age or history of cancer and admission to the ICU, while such an event was less frequent among women.
Among SARS-CoV-2 positive patients with cancer, the risk of adverse events was distinguished by site of primary cancer. After adjusting for sex and age, a statistically significant higher pOR for hospitalisation due to the viral infection emerged for breast, haematological and urological malignancies. As for admission to the ICU, no statistically significant increase in pOR was seen for any of the malignancies considered. A statistically significant higher pOR for death was associated with lung cancer, breast cancer and haematological malignancies.
The authors concluded that in their series there was no statistically significant association between a history of malignancy and SARS-CoV-2 positive status. But the risk of COVID-19 adverse outcomes was significantly higher among patients with cancer, particularly males, older people and those whose cancer has been diagnosed no more than 2 years before becoming SARS-CoV-2 positive. Malignancies involving the breast, urinary tract, blood and lung were associated with a higher risk of adverse clinical outcomes and/or death related to COVID-19.
The study was formally approved by the Bioethics Committee of the Veneto Region, Italy.
Reference
Rugge M, Zorzi M, Guzzinati S. SARS-CoV-2 infection in the Italian Veneto region: adverse outcomes in patients with cancer. Nature Cancer 2020; 1(784-788).