ABSTRACT
Importance: Given concerns that cancer patients may be at increased risk of COVID-19 and may have more severe complications if infected, there have been profound changes to routine cancer care. We aimed to identify risk factors for developing COVID-19 among cancer patients. Methods: We conducted a retrospective cohort study of cancer patients tested for SARS-CoV-2 infection between March 1, 2020 and June 6, 2020 at NewYork-Presbyterian Hospital (NYPH)/Columbia University Irving Medical Center (CUIMC) in New York City. During this time period, all hospitalized patients (starting April 4, 2020) and all symptomatic cancer patients seen in the outpatient clinics were tested for COVID-19. Our primary outcome of interest was COVID-19 test results, defined as positive (SARS-CoV-2 detected on at least one test) or negative (not detected on any COVID-19 tests). Clinical data extraction included: age, sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, Asian, other, unknown), body mass index (BMI), smoking status, time since cancer diagnosis, cancer type, current cancer status, most recent cancer treatment type within the past year, time since last cancer treatment prior to COVID-19 testing, and infusion center visit within the past year. Chi-squared tests and multivariable logistic regression were used to examine the association between demographic, clinical, tumor and treatment-related factors and COVID-19 test results while controlling for covariates. Results: A total of 1,174 cancer patients were tested for COVID-19 with 317 (27%) patients testing positive. Demographic characteristics of the study population included a median age of 67 years (range, 1-103), 55.1% female, and 35.7% non-Hispanic white, 32.5% Hispanic, 15.2% non-Hispanic black, and 4.0% Asian. About 27.2% had a recent cancer diagnosis, 56.7% had active disease, and 56.7% were on active cancer treatment within the past year. In multivariable analysis, older age and higher BMI were associated with COVID-19. Compared to non-Hispanic whites, black and Hispanic cancer patients were more likely to test positive for COVID-19 (odds ratio [OR]=2.21, 95% confidence interval [CI]=1.44-3.40 and OR=2.71, 95% CI=1.91-3.83, respectively). A recent cancer diagnosis, active disease, and active cancer treatment were not associated with COVID-19. Compared to cancer patients not on active treatment, those receiving chemotherapy were less likely to develop COVID-19 (OR=0.65, 95% CI=0.44-0.95). We observed excess deaths among cancer patients who tested positive vs. negative for COVID-19 (28.4% vs. 8.3%, p<0.001). Conclusions and Relevance: Consistent with the general population, we found that older age, minority race/ethnicity, and obesity were associated with COVID-19 among cancer patients. Surprisingly, patients on active treatment including chemotherapy were not at increased risk for COVID-19. Therefore, delays in cancer diagnosis and treatment during the COVID-19 pandemic should be minimized.
ABSTRACT
In March 2020, days after New York shut down to mitigate the spread of COVID-19, we developed a cross-sectional, participant-administered electronic survey to explore how New Yorkers were impacted by and were responding to the ongoing crisis. A critical component of the survey was to assess how credible and trustworthy respondents found various information sources. To advertise and distribute the survey, we embedded an invitation to participate using a popup on the GetHealthyHeights.org website. GetHealthyHeights was designed using community-based participatory research for the medically-underserved, urban, and largely Latinx community of Washington Heights-Inwood, New York City. We received 321 responses from April through July 2020. Participant ages ranged from 25 to 87, and 25% were Latinx. Results showed that the choice of and trust in different COVID-19 information sources were observed to be significantly different across demographic variables, including gender, age, race, and chronic health conditions. In the domains of trust and information source credibility, designers should account for perspectives of diverse subgroups.