People with cancer shouldered 'disparate burden' of COVID-19 mortality during Omicron wave
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Key takeaways:
- The most COVID-19-associated deaths during the winter Omicron wave occurred among people with cancer.
- People with lymphoma experienced the highest increase in COVID-19-associated mortality during that time.
Patients with cancer experienced a greater burden of COVID-19-associated mortality during the winter Omicron wave than the general U.S. population, according to study results published in JAMA Oncology.
Strategies to prevent COVID-19 transmission — particularly among those with cancer — must remain a high priority, researchers concluded.
“Our research was prompted by the relaxation of measures to prevent COVID-19 transmission in the U.S. and specifically across the increasing number of U.S. hospitals that have elected to remove masking mandates,” researcher Chi-Fu Jeffrey Yang, MD, thoracic surgeon in the division of thoracic surgery at Massachusetts General Hospital, told Healio. “Several studies have now shown that patients with cancer are at increased risk for COVID-19 infection and severe COVID-19. During periods of high transmission of the virus, it is possible that patients with cancer may have experienced a disparate burden of COVID-19-associated mortality compared with the general U.S. population, even during periods with variants associated with lower risk for hospital admission and death.”
Rationale and methodology
Potter and colleagues conducted a cross-sectional study to examine monthly COVID-19-associated mortality among people with cancer compared with the general U.S. population.
Researchers used the CDC’s Wide-Ranging Online Data for Epidemiologic Research database to identify 34,350 people with cancer (57.8% men) and 628,156 members of the general population (55.9% men) who died of COVID-19 between December 2020 and February 2022.
Potter and colleagues examined mortality during three pandemic periods — the wild-type period (December 2020 to February 2021), the delta variant period (July 2021 to November 2021) and the winter omicron period (December 2021 to February 2022).
Investigators used mortality ratios to compare the number of deaths from COVID-19 during the omicron surge vs. deaths during the preceding year’s COVID-19 wild-type period.
Findings
The highest number of COVID-19-associated deaths per month among people with cancer occurred during the omicron period (n = 5,958; mortality ratio = 1.04; 95% CI, 1.02-1.05), with 18% more deaths occurring during the peak of the omicron period vs. the peak of the wild-type period.
Conversely, the highest number of COVID-19 deaths per month among the general population occurred during the wild-type period (n = 105,327; mortality ratio = 0.69; 95% CI, 0.69-0.7). During the peak of the omicron period, 21% fewer COVID-19-associated deaths occurred among the general population than during the peak of the wild-type period.
Subgroup analyses that examined trends by cancer type showed the highest increase in COVID-19 mortality during the omicron period vs. wild-type period occurred among people with lymphoma (mortality ratio = 1.38; 95% CI, 1.31-1.45).
The increase in COVID-19 mortality among people with cancer between those two periods appeared consistent for all cancer sites assessed with the exception of brain cancer (mortality ratio = 0.77; 95% CI, 0.65-0.9), thyroid cancer (mortality ratio = 0.76 (95% CI, 0.54-0.99) and bladder cancer (mortality ratio = 0.58; 95% CI, 0.52-0.65).
Researchers acknowledged study limitations, including the potential that the CDC database may have underestimated the number of people with cancer who died of COVID-19. In addition, COVID-19-associated delays in cancer diagnoses and treatment may have contributed to increased COVID-19 mortality among individuals with cancer during the omicron period.
Implications
The findings indicate that patients with cancer experienced a disparate burden of COVID-19-associated mortality during the winter omicron surge, even though the omicron variant has been shown to be associated with lower risk for hospital admission and death among the general population compared with previous variants, Yang told Healio.
“Medically vulnerable groups, such as patients with cancer, continue to be susceptible to COVID-19 even during periods with less virulent variants,” he said. “With the emergence of new variants — including BA.2.86, which has been reported as more transmissible compared with previous variants — there may be a surge in the number of COVID-19 cases diagnosed.
“Therefore, future research should examine new strategies to reduce the risk for severe COVID-19 [among] patients with cancer,” Yang added. “Hospitals and health care settings should strategize on the best and most feasible policies to continue to protect medically vulnerable patient populations.”
For more information:
Chi-Fu Jeffrey Yang, MD, can be reached at cjyang@mgh.harvard.edu.
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