Abstract
BackgroundIt is well established that cancer patients infected with SARS‐CoV‐2 are at particularly elevated risk of adverse outcomes, but the comparison of SARS‐CoV‐2 infection risk between cancer patients and cancer‐free individuals has been poorly investigated on a population‐basis.MethodsA population‐based study was thus conducted in Friuli Venezia Giulia region, northeastern Italy, to estimate prevalence and determinants of SARS‐CoV‐2 infection among cancer patients, as compared to cancer‐free individuals, and to evaluate adverse outcomes of SARS‐CoV‐2 infection. The study included 263,042 individuals tested for SARS‐CoV‐2 in February–December 2020 with cancer history retrieved through the regional cancer registry. Odds ratios (ORs) of SARS‐CoV‐2 positivity, with corresponding 95% confidence intervals (CIs), were calculated using multivariable logistic regression models, adjusted for sex and age. Hazard ratios (HRs) adjusted for sex and age for intensive care unit (ICU) admission and all‐cause death were estimated using Cox models.ResultsAmong 26,394 cancer patients tested for SARS‐CoV‐2, the prevalence of infection was 11.7% versus 16.2% among 236,648 cancer‐free individuals, with a corresponding OR = 0.59 (95% CI: 0.57–0.62). The prevalence was much higher (29% in both groups) during the second pandemic wave (October–December 2020). Among cancer patients, age ≥80 years and cancer diagnosis ≥13 months before SARS‐CoV‐2 testing were the major risk factors of infection. Among 3098 infected cancer patients, the fatality rate was 17.4% versus 15.8% among 23,296 negative ones (HR = 1.63, 95% CI: 1.49–1.78), and versus 5.0% among 38,268 infected cancer‐free individuals (HR = 1.23, 95% CI: 1.12–1.36). No significant differences emerged when considering ICU admission risk.ConclusionAlbeit cancer patients reported reduced SARS‐CoV‐2 infection risk, those infected showed higher mortality than uninfected ones and infected cancer‐free population. Study findings claim for continuing to protect cancer patients from SARS‐CoV‐2, without reducing the level of oncologic care.
Highlights
Biologic and non-biologic factors have been hypothesized to expose cancer patients at higher risk of severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) infection and, as a consequence, at higher risk of COVID-1 9 illness than correspondent uninfected cancer patients.1–4The prevalence of SARS-CoV-2 infection among cancer patients showed large variations in estimates, largely dependent on study design, place, and time of investigation
People tested for SARS-CoV-2 with a history of cancer had a lower prevalence of SARS-CoV-2 infection (11.7%) than cancer-free individuals (16.2%), with a corresponding 41% risk reduction
The findings from this population-based study showed that, between February and December 2020 in northeastern Italy, 26,394 cancer patients who were tested for SARS-C oV-2 by reverse transcription- polymerase chain reaction (RT-PCR) had about 40% lower risk of resulting positive, as compared to 236,648 cancer-free individuals in the general population who were tested in the same geographical area
Summary
Biologic (e.g., immune depression related to anticancer treatments) and non-biologic factors (e.g., most people with cancer needs to interface with health institutions) have been hypothesized to expose cancer patients at higher risk of severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) infection and, as a consequence, at higher risk of COVID-1 9 illness than correspondent uninfected cancer patients.1–4The prevalence of SARS-CoV-2 infection among cancer patients showed large variations in estimates, largely dependent on study design, place, and time of investigation. Several investigations have highlighted that cancer patients infected with SARS-CoV-2 are at elevated risk of adverse outcomes.1,3,6,8–11 A pooled analysis of 52 studies published as of July 2020 projected a high probability of death for infected cancer patients, with a case fatality rate of 25.6%.8. It is well established that cancer patients infected with SARS- CoV-2 are at elevated risk of adverse outcomes, but the comparison of SARS-CoV-2 infection risk between cancer patients and cancer-free individuals has been poorly investigated on a population-b asis. Methods: A population-based study was conducted in Friuli Venezia Giulia region, northeastern Italy, to estimate prevalence and determinants of SARS- CoV-2 infection among cancer patients, as compared to cancer-free individuals, and to evaluate adverse outcomes of SARS-C oV-2 infection. Conclusion: Albeit cancer patients reported reduced SARS-CoV-2 infection risk, those infected showed higher mortality than uninfected ones and infected
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