ABSTRACT
Background: Patients (pts) with cancer are at a higher risk of COVID-19 (C19) severe disease. However, our group and others have demonstrated a low prevalence of C19 infection among asymptomatic pts with cancer on active systemic treatment. We hypothesized this phenomenon was due to increased adherence of pts with cancer to anti-C19 protective measures. This study compares adherence and the perceived importance of such measures in oncologic and non-oncologic populations. Methods: This is a cross-sectional study conducted between June and September 2021. A questionnaire was developed to assess how participants perceived and adhered to masking, handwashing, and other anti-C19 protective measures. Demographic information, educational level, and monthly income were also collected. Three groups were included: A) pts with cancer treated at Hospital de Base (HB);B) pts without cancer treated at HB for other medical conditions;C) a healthy outpatient population. Data were summarized in means, medians, and proportions. Chi-squared or Fisher's exact test was used to compare categories;ANOVA was employed to compare means. A multivariable analysis assessing factors associated with adherence to anti-C19 protective measures was performed. Results: A total of 607 people were interrogated (200 in groups A and B, and 207 in C). The mean age of groups A, B, C was significantly different: 60 vs. 52 vs. 35 years old (p < 0.001). Group C had a higher educational level and a higher monthly income than groups A and B (p < 0.001). In cohort A, gastrointestinal, breast, and genitourinary were the most frequent tumors (33%, 31%, 15%);75% of pts had active disease. Pts with cancer were more adherent to anti-C19 protective measures: of 33 points, the mean score of groups A, B, C was respectively 27.8 vs. 25.5 vs. 21.9 (p < 0.001). Regarding the importance of anti-C19 protective measures, pts with cancer also perceived those as more relevant: of 21 points, the mean score of groups A, B, C was respectively 17.8 vs. 17 vs. 16.9 (p < 0.001). For instance, in group A, 95% report consistently wearing a mask when leaving home compared to 90% and 58.2% of groups B and C. In line with our findings, 20.5% vs. 32.5% vs. 35.3% (p < 0.003) of groups A, B, and C reported having C19 before the questionnaire. In multivariable analysis, groups B and C were less likely to adhere to anti-C19 protective measures than group A. Conclusions: Pts with cancer are more adherent to anti- C19 protective measures and perceive them as more important than non-oncologic populations. Our results shed light on the accumulating literature of a low incidence of C19 amongst asymptomatic pts with cancer on systemic treatment even during the surges. Such findings are possibly related to the fact that cancer pts are more vulnerable to hospitalizations and unfavorable outcomes than the general population, prompting a more risk-averse behavior.
ABSTRACT
Background: Patients with cancer, both active and previously treated, are at a higher risk of developing severe outcomes from COVID-19. During the pandemic, health care systems (HCS) have adapted the delivery of care, and disparities between private and public systems became even more striking. In Brazil, where 70% of the population depends on the public system, ICU demands largely exceed the capacity in most public centers, whereas in private centers the situation is less challenging. Herein we compare outcomes of patients with cancer and COVID-19 treated in the public and private HCS in Brazil. Methods: We used data from adult patients with solid malignancies who tested positive for COVID-19 and were admitted to two tertiary centers in the state of São Paulo. Patients who tested positive for SARS-CoV2 RNA real-time polymerase chain reaction (RT-PCR) were included. We collected data on baseline clinical conditions, cancer and treatment. Patients were classified by HCS: public system (public) versus (vs) private insurance coverage (private). The co-primary endpoints were all-cause mortality and a composite endpoint consisting of intensive-care-unit (ICU) admission, mechanical ventilation or death (ICU-MV-D). Chi-square, Fisher's exact test and Mann-Whitney U test were used when appropriate. We assessed the association between outcomes and HCS using logistic regression analyses, adjusting for age, sex, current anticancer treatment and comorbidities. Results: From March 16 to October 20 2020, 124 patients were identified. Of those, 90 (72%) were from the public and 34 (28%) from the private HCS. There were no statistical differences in sex, smoking, primary tumor siteand staging between patients from both HCS. Conversely, patients treated in the private system were older [66 (SD 13.8) vs 74 (SD 15.1), p=0.004], had more comorbidities (64.7% vs 37.8% p=0.009), and were on anticancer treatment more frequently (64.7% vs 34.4% p=0.004) compared to public patients. There were no differences in all-cause mortality (public 40% vs private 44.1% p=0.69) between patients treated at the different HCS. Nevertheless, in the composite outcome, private system was significantly associated with increased risk of ICU-MV-D compared to the public system (79.4% and 57.8% p=0.030, respectively). The median time from COVID-19 diagnosis to ICU-MV-D was 13 vs 8 days (p=0.031) and to death was 25 vs 24 days (p=0.24), respectively for public and private HCS patients. In the multivariable logistic regression, HCS was not associated with death [adjusted odds ratio (aOR)=1.16 p=0.75] or ICU-MV-D (aOR=0.55, p=0.27). Conclusion: While patients in the private system were older and had more comorbidities, there were no differences in inpatients all-cause mortality between private and public systems. However, private patients were associated with increased ICU-MV-D. We hypothesize that these findings may reflect disparities in ICU availability, known to be higher in the private system. Further studies investigating this hypothesis are warranted. EDR and DVA co-senior authors.