Brianna M. Jones, MD Radiation Oncology Resident Icahn School of Medicine at Mount Sinai

Increased Risk of COVID-19 Deaths and Severe Disease Among Cancer Patients Interview with:

Brianna M. Jones, MD Radiation Oncology Resident Icahn School of Medicine at Mount Sinai

Dr. Jones

Brianna M. Jones, MD
Radiation Oncology Resident
Icahn School of Medicine at Mount Sinai What is the background for this study?

Response: The COVID-19 pandemic has resulted in over 4 million deaths worldwide and, presently, there have been over 2 million cases diagnosed in New York. There have been numerous studies that demonstrate cancer patients are at increased risk of diagnosis and mortality to SARS-CoV-2 virus. Several studies have also noted socioeconomic status and race/ethnicity are associated with poorer outcomes.

Within NYC, Elmhurst Hospital Center (EHC) emerged as an early epicenter in spring of 2020. The surrounding catchment area of EHC consists of a population that is 54% Latino, 33% Asian, 6% White, 4% Black, 1% Native American, and 1% other according to U.S. Census Bureau, making it one of the most racially and ethnically diverse populations in the country. Its residents are predominantly working-class immigrants with limited resources that work jobs now considered essential (e.g., delivery workers, grocery shops, et cetera). EHC continued to offer a range of cancer services throughout the pandemic.

Given the high infection rate and diverse population at EHC, our study provides an opportunity to evaluate outcomes in one of the hardest hit communities to date. Therefore, our aim was to investigate patient characteristics, clinical outcomes, and predictors of COVID-19 diagnosis, severity, and mortality in patients with an active cancer diagnosis at EHC. What are the main findings? Were there certain cancers or ethnic groups more susceptible to COVID mortality?

Response: In this retrospective cohort study of 266 patients with an active cancer diagnosis at EHC between January 2020 – June 2020, we found cancer patients were at increased risk for mortality (rate of 30%) and severe events (rate of 50%) due to the SARS-CoV-2 infection compared to the general population (estimated to be approximately 2%). A higher proportion of COVID positivity, severity and mortality was seen in patients who were males, Hispanic ethnicity, Medicaid insured, and received cytotoxic chemotherapy compared to COVID negative patients with active cancer.

We did not find any association between cancer type and COVID positivity or severe sequelae although we did find a slightly higher proportion of these patients undergoing cancer-directed therapy with curative intent. Of COVID deaths, median time from last cancer treatment was 15 days. We did not find any significant predictors of COVID diagnosis, severity, or mortality likely due to the limited sample size. What should readers take away from your report?

Response: To our knowledge, this is one of the first studies to directly compare patients with active cancer without COVID to patients with active cancer and COVID. Additionally, our study provides COVID outcomes in cancer patients in an urban, racially and ethnically diverse, public health system in the epicenter of the pandemic in the spring of 2020. We found cancer patients were at increased risk of death (30%) or severe COVID (50%). Importantly, there was a disproportionate burden of COVID morbidity and mortality in patients of Hispanic ethnicity and certain insurance types. The pandemic has highlighted the vulnerability of the population in this neighborhood, and our experience here at Elmhurst highlights the health disparities that exist in many communities such as ours. What recommendations do you have for future research as a result of this work?

Response: Throughout the pandemic, cancer-directed therapies were modified to minimize risk to cancer patients and the indirect oncologic outcomes of these modifications will need to be evaluated in future studies. Additionally, our study had limited statistical power to fully evaluate predictors of COVID diagnosis, severity, and mortality and so larger studies of cancer patients will need to be performed to further evaluate. Future studies should continue to evaluate whether race, ethnicity, socioeconomic status, and insurance status has any impact on COVID outcomes. Is there anything else you would like to add?

Response: It is an oversimplification to believe COVID-19 discriminates based on gender, race, and/or ethnicity, rather, the aforementioned disparities point to a larger social framework that impacts healthcare in underserved communities.  In view of the recent surge in cases due to the highly infectious B.1.617.2 (delta) variant and other variants throughout the globe coupled with a potential modest decrease in vaccine effectiveness against certain variants, the SARS-CoV-2 continues to be a significant threat to vulnerable patient populations. It is vital that the medical community works towards mitigation strategies and widespread vaccination of cancer patients, particularly those in vulnerable populations.

I have no disclosures. Thank you so much for inviting me to participate in this interview and provide a platform for our research team to present these interesting findings.


ASTRO 21 Presentation October 2021

Clinical Characteristics and Mortality in Patients with Cancer and COVID-19 from the Epicenter in New York City
Brianna M. Jones MD, Eric J. Lehrer MD, MS, Lucas Resende Salgado MD, MPA, Zahra Shafaee MD, Virginia W. Osborn MD

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Last Updated on November 1, 2021 by Marie Benz MD FAAD