Risk Factors for COVID-19-Related Hospitalization and Death in Patients With Cancer: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS).

in JAMA oncology by Brian I Rini, Ana F Best, Mel D Bowman, Grace E Mishkin, Andrea M Denicoff, Larry V Rubinstein, Lyndsay Harris, Ann M Geiger, Nicholas M Mark, Steven A Pergam, Jeremy L Warner, Alok A Khorana, Sacha Gnjatic, Tina W F Yen, Darla K Liles, Christine M Bestvina, Neil J Shah, Jacqueline T Norrell, Dawn L Hershman, Jennifer L Holter-Chakrabarty, Andrew S Poklepovic, Stephen J Chanock, Hari Sankaran, Larissa A Korde

TLDR

  • The study found that patients with cancer who receive chemotherapy, have a prior history of cardiovascular disease, or are unvaccinated for SARS-CoV-2 are at higher risk of COVID-19 hospitalization and death.
  • The study highlights the importance of personalized treatments and vaccinations for patients with cancer to mitigate the impact of COVID-19.

Abstract

Retrospective case series have identified having cancer and receiving treatment for cancer as risk factors for inferior COVID-19 outcomes. To determine risk factors for hospitalization and death in patients with cancer with COVID-19 infection. The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) is a prospective longitudinal natural history cohort study examining the impact of COVID-19 on patients with cancer. Adults were eligible within 14 days of an initial positive SARS-CoV-2 test result if they were receiving active treatment for cancer or had prior stem cell/bone marrow transplant or CAR T-cell treatment. The statistical analysis took place between September 2024 and April 2025. The primary objective of the study was to determine patient factors, therapy types, and cancer types associated with COVID-19 severity, defined as hospitalization for or death from COVID-19 within 30 and 90 days after the first positive SARS-CoV-2 test result. Multivariable regressions were performed for COVID-19-specific hospitalization and mortality (proportional hazard and cause-specific hazard models). Of 1572 eligible adult patients (median [range] age, 60 [18-93] years; 840 female [53.4%]), 1066 (67.8%) had a solid tumor, with 683 (64.0%) having metastatic disease; breast (252 [23.6%]) and lung cancer (148 [13.9%]) were most common. At enrollment, 1013 patients (64.4%) were unvaccinated for SARS-CoV-2. COVID-19-related mortality at 90 days was 3.0% and did not increase at subsequent time points. The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers. In multivariable analysis, receipt of chemotherapy (hazard ratio [HR], 1.97; 95% CI, 1.52-2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR, 1.78; 95% CI, 1.33-2.38) were associated with a higher risk of hospitalization. Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70). Over 2 years of follow-up, there were 1739 cancer treatment disruptions, of which 881 (50.7%) were attributed to COVID-19, with most disruptions occurring within the first 30 days. The results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.

Overview

  • The study aimed to identify patient factors, therapy types, and cancer types associated with COVID-19 severity in patients with cancer.
  • The study enrolled 1572 eligible adult patients with cancer who had received a positive SARS-CoV-2 test result within 14 days.
  • The study examined the impact of COVID-19 on patients with cancer, including hospitalization, treatment disruptions, and death.

Comparative Analysis & Findings

  • The study found that receipt of chemotherapy increased the risk of hospitalization for COVID-19 (HR, 1.97; 95% CI, 1.52-2.54).
  • Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70).
  • The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers.

Implications and Future Directions

  • The study highlights the need for personalized treatments and vaccinations for patients with cancer to mitigate the impact of COVID-19.
  • Future studies should focus on identifying biomarkers to predict COVID-19 severity in patients with cancer and developing targeted therapy strategies.
  • Further research is needed to understand the long-term effects of COVID-19 on patients with cancer and to develop strategies for cancer treatment disruptions.
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