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Background: Data on the effectiveness of the bivalent booster vaccine against COVID-19 breakthrough infection and severe outcomes is limited. Method(s): Using patient-level data from 54 sites in the U.S. National COVID Cohort Collaborative (N3C), we estimated bivalent booster effectiveness against breakthrough infection and outcomes between 09/01/2022 (bivalent vaccine approval date) to 12/15/2022 (most recent data release of N3C) among patients completed 2+ doses of mRNA vaccine. Bivalent booster effectiveness was evaluated among all patients and patients with and without immunosuppressed/compromised conditions (ISC;HIV infection, solid organ/ bone marrow transplant, autoimmune diseases, and cancer). We used logistic regression models to compare the odds of breakthrough infection (COVID-19 diagnosis after the last dose of vaccine) and outcomes (hospitalization, ventilation/ECMO use, or death <=28 days after infection) in the bivalent boosted vs. non-bivalent boosted groups. Models controlled for demographics, comorbidities, geographic region, prior SARS-CoV-2 infection, months since the last dose of non-bivalent vaccine, and prior non-bivalent booster. Result(s): By 12/15/2022, 2,414,904 patients had received 2+ doses of mRNA vaccination, 75,873 of them had received a bivalent booster vaccine, and 24,046 of them had a breakthrough infection. At baseline, the median age was 52 (IQR 36-67) years, 40% male, 63% white, 10% Black, 12% Latinx, 3.5% Asian American/Pacific Islander, and 14% were patients with ISC. Patients received a bivalent booster were more likely to be female and had comorbidities. Bivalent booster was significantly associated with reduced odds of breakthrough infection and hospitalization (Figure). The adjusted odds ratios comparing bivalent vs. non-bivalent group were 0.28 (95% CI 0.25, 0.32) for all patients and 0.33 (95% CI: 0.26, 0.41) for patients with ISC. Compared to the nonbivalent group, the bivalent group had a lower incidence of COVID-19-related hospitalization (151 vs. 41 per 100,000 persons), invasive ventilation/ECMO use (7.5 vs. 1.3 per 100,000 persons), or death (11 vs. 1.3 per 100,000 persons) in all patients during the study period;the incidence of severe outcomes after bivalent boosting was similar among patients with and without ISC. Conclusion(s): A bivalent booster vaccine was highly effective against COVID-19 breakthrough infection and severe outcomes among patients received 2+ doses of mRNA vaccine and offered similar protection in patients with and without ISC. (Figure Presented).
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To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18–45). The current study leverages a national, cross-sectional sample of US adults ages 18–45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of ‘no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20;95 % CI: 1.99–5.13), being a parent/guardian (OR: 1.77;95 % CI: 1.18–2.66), having at least one healthcare visit in the past year (OR: 1.97;95 % CI: 1.10–3.53), being up-to-date on the tetanus vaccine (OR: 1.81;95 % CI: 1.19–2.75), and being a cancer survivor (OR: 2.57;95 % CI: 1.52–4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic. © 2022 The Authors
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Background: Patients with SARS-CoV-2 with a diagnosis of cancer have increased risk of severe COVID-19 outcomes compared to patients without cancer. However, little is known regarding outcomes of patients with COVID-19 and cancer in the setting of human immunodeficiency virus (HIV). Given the unique risks of this population, we sought to understand COVID-19 outcomes using registry data. Methods: This is a descriptive research study utilizing the CCC19 registry, an international multi-institutional registry with healthcare provider-reported cases of patients with cancer and COVID-19. Between March 2020-December 2021, 116 persons with HIV (PWH) and 10,642 persons without HIV (PWOH) with laboratory-confirmed SARS-CoV-2 infection were identified as eligible for the analysis. Results: Median follow-up time for both groups was 90 days, with interquartile range (IQR) 30-180 days. Most PWH were actively receiving antiretroviral therapy (ART) at the time of COVID-19 diagnosis, with 71% (n = 82) having named drug information available;bictegravir/emtricitabine/tenofovir was the most common ART (n = 25). PWH were of younger age (median 57.5 yrs [IQR 46.5-63.25] vs 65 yrs [IQR 55-74]), male (81% vs 47%), and either non-Hispanic Black or Hispanic (71% vs 34%) compared to PWOH. 12% of PWH (n = 14) were current smokers compared to 6% of PWOH (n = 638), and more than half in each group were never smokers (51% of PWH and 53% of PWOH). The following comorbidities were identified in PWH vs PWOH: cardiovascular (16% vs 20%), pulmonary (16% vs 20%), renal (15% vs 14%), and diabetes mellitus (18% vs 27%). A higher proportion of PWH had hematologic malignancy compared to PWOH (33% vs 19%). More PWH had active cancer which was progressing at the time of SARS-CoV-2 infection compared to PWOH (24% vs 14%). 44% of PWH (n = 51) had received active systemic anticancer therapy within the 3 months preceding SARS-CoV-2 infection (including cytotoxic, targeted, endocrine therapies, and immunotherapy) compared to 51% of PWOH (n = 5,420). PWH had an increased rate of hospitalization (58% vs 55%) compared to PWOH. Although a lower proportion of PWH required supplemental oxygen during hospitalization compared to PWOH (34% vs 38%) and ICU admission rates were identical between the two groups (16% vs 16%), PWH had an increased rate of mechanical ventilation (14% vs 10%) and death (24% vs 18%) compared to PWOH. Conclusions: This is the first known study describing outcomes of patients with cancer and COVID-19 in the PWH population from a large multinational dataset. PWH have characteristics associated with adverse outcomes in prior analyses (male sex, non-Hispanic Black or Hispanic, hematologic malignancy, progressing cancer) but are notably younger and have fewer comorbidities. HIV infection may portend increased risk of severe COVID-19 and death;however, additional analyses, including multivariable regression, are warranted.
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Background: The COVID-19 pandemic has led to disruptions in cancer treatment delivery among breast cancer patients in the U.S. However, it is currently unknown whether racial/ethnic disparities exist in cancer treatment disruptions among patients with breast cancer and SARS-CoV-2 infection. Methods: We obtained data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021) describing breast cancer patients diagnosed with SARS-CoV-2 during their care treated at 46 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, breast cancer characteristics, and modifications to cancer treatment plans. Breast cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the originally scheduled date. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, number of comorbidities, cancer extent, ECOG performance score, pandemic period based on case peaks (< 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Breast cancer patients (n = 804) with SARS-CoV-2 were mostly aged 50 years and above (75%) and urban residents (83%). The racial/ethnic makeup of the sample included: 13.3% non-Hispanic Black/African American (NH-Black), 11.7% Hispanic/Latinx, 4.9% American Indian/Alaskan Native (NH-AI/ AN), 4.6% NH-Asian, and 65% NH-White. At SARS-CoV-2 diagnosis, 736 patients (91%) were scheduled to receive drug-based therapy (78%), radiation therapy (8%), or surgery (6%), of whom 39% experienced TDD. Across treatment modalities, the most commonly reported TDD reason from the clinic perspective was the patient's COVID-19 disease (∼90%). Overall, NH-Black (62%), Hispanic/Latinx (44%), and NH-Asian (42%) adults with breast cancer and SARS-CoV-2 were more likely to experience TDD versus NH-White adults (34%) (p < 0.001). In multivariable analyses, NH-Black cancer patients were more likely to experience TDD compared to NH-White patients (aOR: 3.12, 95% CI: 1.96-5.47). The data suggest Hispanic/Latinx (aOR: 1.34, 95% CI: 0.78-2.30) breast cancer patients may also experience TDD, although not statistically significant. No association was observed among NH-Asian (aOR: 1.16, 95% CI: 0.50-2.73) or NH-AI/AN (aOR: 0.64, 95% CI: 0.28-1.52) breast cancer patients with TDD. Conclusions: Black or African American breast cancer patients are more likely to experience cancer care disruptions during the pandemic. Future research should evaluate the long-term impacts of care disruptions on breast cancer outcomes among minoritized US communities.
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Background: U.S. rural cancer patients experience multifactorial barriers to cancer treatment;however, little is known about the impact of the pandemic on cancer treatment delays or discontinuations (TDD) in the rural context. Our objective was to evaluate the role of rurality at both the patient and clinic level on cancer TDD among patients living with cancer with SARS-CoV-2 infection. Methods: We used data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021), which includes cancer patients diagnosed with SARS-CoV-2 (n = 3193). Data included patient demographics, SARSCoV- 2 treatment, cancer characteristics, and modifications to cancer treatment plans. Cancer-related TDD was defined as any treatment postponed > two weeks from the original scheduled date. Rurality was defined using the USDA Rural-Urban Commuting Area schema. We compared cancer characteristics, COVID-19 outcomes, and TDD by rurality of cancer patients, and TDD by rurality of oncology practices. We computed adjusted odds ratios (aOR) using multivariable logistic regression to evaluate rurality with TDD adjusting for age, race/ethnicity, sex, comorbidities, ECOG score, cancer extent, pandemic time period based on case peaks (< 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity. Results: Rural cancer patients (n = 499, 16%) with SARS-CoV-2 were mostly over 50 years (87%), female (57%), and NH-White (81%) with solid tumors (76%). Most rural patients received oncology treatment in urban areas (65%, p < 0.001). Rural patients were less likely to receive care through telemedicine (18%) compared to urban patients (26%) (p < 0.001). At SARS-CoV-2 diagnosis, rural patients were scheduled to receive drug-based therapy (72%), radiation therapy (8%), surgery (4%), or transplant (1%). Rural versus urban cancer patients with SARS-CoV-2 were less likely to experience TDD (41% vs. 51%) (p < 0.001). Among patients treated at rural oncology clinics, urban cancer patients were more likely to experience TDD (65%) compared with rural patients (47%) (p < 0.001). Similarly, among patients treated at urban oncology clinics, urban cancer patients were also more likely to experience TDD (51%) compared with rural patients (38%) (p < 0.001). In multivariable analyses, rural cancer patients were 28% less likely to experience TDD (aOR:0.72, 95% CI: 0.55- 0.94) than urban cancer patients. Oncology practice rurality was not associated with TDD (aOR: 1.19, 95% CI: 0.81-1.76). Conclusions: Rural cancer patients were less likely to experience TDD than urban patients supporting the urban-rural paradox i.e., geographic distance to cancer care facilities is not consistently associated with treatment delivery in expected ways. Future work should focus on area-level factors of the rural cancer patient experience to disentangle potential reasons for TDD during the pandemic.
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Background: Due to societal factors in the US, racial/ethnic minority adults are disproportionately impacted by the COVID-19 pandemic, particularly those with existing comorbid conditions such as cancer. It is currently unknown whether disparities exist in cancer treatment delivery among racial/ethnic minority patients with cancer and SARS-CoV-2. Methods: Data were obtained from the ASCO COVID-19 and Cancer Registry (March 2020-July 2021), including data from cancer patients diagnosed with SARS-CoV-2 during their care (n=3193) at 60 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, cancer clinical characteristics, and modifications to cancer treatment plans. Cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the original scheduled date. We descriptively evaluated demographic and clinical characteristics, compared disparities in TDD by race/ethnicity and urban/rural residency, and evaluated reasons for TDD as reported by the clinics. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, body mass index, number of comorbidities, cancer type, cancer extent, cancer status at SARS-CoV-2 diagnosis (progressing/stable) and SARS-CoV-2 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Cancer patients with SARS-CoV-2were mostly female (57%), urban residents (84%), and NH-White (66%);49% were 65+ years old. Most patients had solid tumors (75%). At SARS-CoV-2 diagnosis, 2403 patients (76%) were scheduled to receive drug-based therapy (69%), radiation therapy (7%), surgery (4%), or transplant (0.7%), of whom 49% experienced TDD. The most reported TDD reason from the clinic perspective was the patient's COVID-19 disease (90%). Overall, NH-Black (64%) and Hispanic (57%) with SARS-CoV-2 were more likely to experience TDD versus NH-White adults (46%) (p<0.001). This disparity was also observed across urban residing adults (p<0.001). Among rural adults, NH-AI/AN (75%) and NH-Black (61%) were more likely to experience TDD versus NH-White patients (39%). In multivariable analyses, disparities persisted, by NH-Black cancer patients with 92% (aOR:1.92, 95% CI:1.24-2.96) and Hispanic patients with 41% (aOR:1.41, 95% CI:1.03-1.91) higher odds of experiencing TDD. We observed consistent results among urban and rural subgroups. Conclusion: Racial/ethnic disparities exist in TDD among cancer patients with SARS-CoV-2 in urban and rural care settings. Future studies should evaluate the impacts of delays to cancer treatment delivery on cancer outcomes among minoritized communities in the US.
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Background: Real-world evidence on effectiveness of booster or additional doses of COVID-19 vaccine is limited. Methods: Using patient-level data from 50 sites in the U.S. National COVID Cohort Collaborative (N3C), we estimated COVID-19 booster vaccine effectiveness compared to full vaccination alone (completed 2 doses mRNA or 1 dose Janssen vaccine). At each month following full vaccination, we created comparable cohorts of patients with boosters propensity-score matched to those without boosters by age, sex, race/ethnicity, comorbidities, geographic region, prior COVID-19 infection, and calendar month of full vaccination. Booster efficacy was evaluated among patients with and without immunosuppressed/compromised conditions (ISC;HIV infection, solid organ or bone marrow transplant, autoimmune diseases, and cancer). We used Cox regression models to estimate hazards of breakthrough infection (COVID-19 diagnosis after last dose of vaccine) and logistic regression models to compare the risk of death ≤45 days after a breakthrough infection in the boosted vs. matched non-boosted groups. Results: By 11/18/2021, 656390 patients had received full vaccination, and 125409 fully vaccinated had received an additional booster (median time from last vaccine to booster dose: 7.4 months, IQR:6.6, 8.2). At completion of full vaccination, median age was 50 (IQR 33-64) years, 43% male, 50% white, 11% Black, 18% Latinx, 4.8% Asian American/Pacific Islander, and 20% had ISC. People receiving a booster were more likely to be older, male, white, and have ISC. Booster vaccine was significantly associated with a reduced hazard of breakthrough infection (Table). Booster efficacy ranged from 46% (booster receipt 1-4 months after full vaccination) to 83% (receipt 7 months after full vaccination) in people without ISC. Vaccine efficacy was lower, ranging from 43%-65%, in ISC patients (Table). Compared to fully vaccinated patients without booster receipt, patients with booster had an 83% (OR: 0.17, 95% CI: 0.11, 0.28) reduced risk of COVID-19 related death, independent of demographics, geographic region, comorbidities, ISC, prior COVID-19 infection, and time of full vaccination. Conclusion: A booster dose of COVID-19 vaccine has high effectiveness in reducing breakthrough infection risk among all fully vaccinated individuals, though only with moderate effectiveness among ISC patients. Nonetheless, booster vaccination significantly reduced risk for COVID-19 related death regardless of ISC status.
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Background: Food insecurity can negatively impact adherence to and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19 associated food insecurity among cancer survivors to adults without a history of cancer and (2) examine determinants associated with COVID-19 related food insecurity among cancer survivors. Methods: We used nationally-representative data from the COVID-19 Household Impact Survey (n = 10,760), collected at three time points: April 20-26, May 4-10, and May 30-June 8 of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized on how often (response options: often true, sometimes true, never true) participants reported the following: “We worried our food would run out before we got money to buy more” or “The food that we bought just didn't last, and we didn't have money to get more”;respondents were categorized as food insecure if they chose often true or sometimes true. We also examined use of food pantry assistance or Supplemental Nutrition Assistance Program benefits during the pandemic period;respondents were also categorized as food insecure if they received or applied for these benefits. We compared reported food insecurity among cancer survivors to other U.S. adults using Chi-square tests. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Results: Thirty-two percent of cancer survivors were food insecure. Cancer survivors aged 30-44 years and those aged ≥60 were more likely to report being food insecure compared to respondents without a history of cancer in the same age categories (30-44 years, 59.9% versus 41.2% p = 0.01, ≥60 years 27.2% versus 20.2%, p = 0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults without a high school diploma and no history of cancer (87.0% versus 64.1%, p = 0.001). In examining determinants of food insecurity among cancer survivors, adults aged 45-49 years when compared to those ages ≥60 (aPR = 1.54, 95% CI 1.16-2.03), adults with no high school diploma (aPR = 2.63, 95% CI 1.53-4.50) or a high school degree (aPR = 1.94, 95% CI 1.08-3.49) compared to those with a baccalaureate or above, adults with an annual household income <$30,000 (aPR: 2.16, 95% CI: 1.15-4.07) compared to those earning ≥$100,000, and cancer survivors in rural areas (aPR = 1.51, 95% CI 1.07-2.12) compared those living in urban areas were more likely to report being food insecure. Uninsured cancer survivors (aPR: 2.39, 95% CI: 1.46-3.92) and those on Medicaid (aPR: 2.10, 95% CI: 1.40-3.17) were more likely to report being food insecure than their counterparts. Conclusions: Food insecurity during the COVID-19 pandemic is vast but varies considerably among cancer survivors and adults without a history of cancer. Among cancer survivors, differences in food insecurity were observed by age, SES, and area of residence.
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Background: Cancer survivors often experience financial hardship due to high costs associated with cancer treatment. Our objective was to (1) identify determinants of financial hardship, and to (2) evaluate the impact of financial hardship on mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: We used nationally representative data from the COVID-19 Household Impact Survey collected at three-time points: April 20-26, May 4-10, and May 30th -June 8 th of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). We defined financial hardship using the following question: “Suppose you have an unexpected expense that costs $400. Based on your current financial situation, how would you pay for this expense?” Respondents were categorized as experiencing financial hardship if they chose the following options: I wouldn't be able to pay for it right now;sell something;use a payday loan, deposit advance, or overdraft;borrow from a friend or family member. Chi-square (χ2 ) tests were used to compare reported financial hardship among cancer survivors to other U.S. adults. Multivariable Poisson regression was used to identify determinants of financial hardship among cancer survivors. We used multinomial logistic regression to evaluate associations of financial hardship on mental health symptoms of cancer survivors. Results: Eighteen percent of cancer survivors reported experiencing financial hardship. Cancer survivors aged 30-44 (44.8%) and 45-59 years (25.9%) more frequently reported financial hardship compared to adults without cancer (23.4%, 16.7%, respectively, χ2p<0.05). Compared to cancer survivors aged 60+ years, those aged 18-29 (aPR: 2.54, 95% CI;1.51-4.28), 30-44 (aPR:3.41, 95% CI:2.26-5.16), and 45-59 years (aPR:3.66, 95% CI:2.26-5.16) were more likely to experience financial hardship. Cancer survivors on Medicaid (aPR: 1.76, 95% CI: 1.16-2.66) were more likely to experience financial hardship compared to their counterparts. Compared to those without a high school degree, cancer survivors with some college education (aPR: 0.30, 95% CI: 0.18-0.47) and with a ≥Baccalaureate degree (aPR:0.05, 95% CI: 0.02- 0.14) were less likely to experience financial hardship. Rural cancer survivors had 61% higher prevalence of financial hardship compared to urban residents (aPR: 1.61, 95% CI:1.00-2.58), however, suburban residents were less likely to experience financial hardship compared to cancer survivors living in urban areas (aPR: 0.65, 95% CI:0.44-0.98). Cancer survivors who experienced financial hardship were more likely to report feeling depressed (aOR: 2.78, 95% CI: 1.39-5.56), lonely (aOR: 3.06, 95% CI: 1.39-6.72), and hopeless (aOR: 3.16, 95% CI: 1.36-7.37) 3-7 days during the last 7 days. Conclusion: Lower SES measures and younger age were determinants of experiencing financial hardship among cancer survivors. During the COVID-19 pandemic, there is a high burden of mental health symptoms among cancer survivors experiencing financial hardship.
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Background: The use of medical cannabis represents an opportunity to improve access to equitable cancer treatment among minoritized populations who frequently face barriers to traditional palliative care options or mental health treatments. Poor mental health among cancer survivors is of concern as it reduces adherence to cancer survivorship treatment and can reduce overall survival. The COVID-19 pandemic has highlighted the importance of access to palliative care due to the increase of mental health symptoms among cancer survivors. Despite the potential benefits of medicinal cannabis, data describing the use of cannabis to manage mental health symptoms among cancer survivors is limited, particularly in the context of the COVID-19 pandemic. Objective: Our objective was to examine the prevalence of mental health symptoms and the behavioral impacts of the COVID-19 pandemic on cancer survivors who endorse cannabis use. Methods: Our participants included adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (03/21/2020-03/24/2021). Overall, we received 3,594 responses. For this study, data included 158 participants including 79 cancer survivors (2.2%) along with age-matched medicinal cannabis users without a history of cancer (N = 79). Descriptive statistics were used to compare demographic characteristics, prevalence of generalized anxiety (GAD-7), and depression (CES-D-10), changes in behavior during the COVID-19 pandemic, and self-reported coping mechanisms by cancer survivorship status. Results: Overall, 61% and 48% of cancer survivors self-reported to use medicinal cannabis to manage their anxiety and depression, respectively. Additionally, 54% of cancer survivors reported cannabis use to manage their chronic pain. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of things at home, or get along with other people (23.0% vs. 11.8%, p = 0.015) than adults without a history of cancer. Pandemic-related coping mechanisms frequently reported by cancer survivors with anxiety or depression included more sleep (47.5%), practicing meditation/mindfulness (47.5%), physical activity (47.5%), talking to family and friends (42.5%), overeating or stress-eating (25.0%), and using more cannabis (25.0%). Cancer survivors with anxiety and depression reported to be more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p=0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p<0.001) compared to cancer survivors without mental health conditions. Conclusion: Given the prevalence of anxiety and depression symptoms reported among cancer survivors and their use of cannabis, further research is recommended to evaluate its use as palliative care to improve mental health and quality of life among cancer survivors.
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Background: The role of immunosuppression/compromise (ISC) in risk of severe COVID-19 is unknown. While ISC could reduce control of SARS-CoV-2 viremia, it might also dampen the severe immune response to the virus;data comparing ISC groups is limited. Methods: Using patient-level data from 34 sites in the U.S. National COVID Cohort Collaborative (N3C), we compared risk of COVID-19 hospitalization amongst COVID-19 patients in 3 ISC groups (1,300 persons with HIV [PWH];2,142 solid organ transplant [SOT] patients;41 PWH with SOT) to 288,743 COVID-19 patients without HIV or SOT (HIV-/SOT-). COVID-19+ was defined by RT-PCR, antibody test, or diagnostic codes. HIV infection, SOT and comorbidities were defined by conditions/diagnostic codes within 2 years prior to first COVID-19+. Hospitalization was defined by inpatient care between 14 days prior to 45 days after the first COVID-19+. Odds ratios of hospitalization were estimated using multivariable logistic regression models adjusting for demographics, study site, and comorbidities (severe liver disease, diabetes, cancer, kidney disease, and total comorbidities [0, 1, 2, ≥3]). Results: Of 292,226 COVID-19+ patients, the median age was 41 years (IQR: 25-58), 46% male, 47% non-Hispanic white (NHW), and 17% non-Hispanic black (NHB). PWH and SOT patients, respectively, were more likely to be older (median: 50 & 56), male (70% & 60%), and had ≥ 3 comorbidities than overall N3C patients (30% & 64% vs. 8%). PWH were more likely to be NHB (50%) and SOT patients were more likely to be NHW (41%). Overall, 26% of HIV-/ SOT- COVID-19 patients were hospitalized. In crude analyses with HIV-/SOT- as the referent group (Table), COVID-19 patients with HIV, SOT or both had a 2.3, 4.4, or 6.9-fold increased odds of hospitalization, respectively. After adjustment for demographics and site, the risk was attenuated but remained statistically significant (Model a). Sequential adjustment for the type and number of comorbidities obviated the estimated risk among PWH, while SOT patients had persistently increased odds of hospitalization (Model b). Conclusion: ISC patients (PWH and SOT) are more likely to be hospitalized with COVID-19 independent of demographics. However, this increased hospitalization risk was driven mainly by the high burden of comorbidities in both groups. Only SOT patients had an independent risk of hospitalization after adjusting for comorbidities. Ongoing analyses will examine the impact of ISC on additional COVID-19 outcomes (i.e. ventilation use, death).
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Background: Morbidity and mortality due to COVID-19 disproportionately impacts racial/ethnic minorities and adults with chronic diseases, potentially including people living with HIV (PLWH). Here, we present descriptive patient characteristics by COVID-19 positive and HIV status using the U.S. National COVID Cohort Collaborative (N3C). Methods: Using N3C data, we conducted a retrospective cohort analysis of patients aged ≥ 18 years that had undergone COVID-19 testing. The N3C cohort includes patients with any encounter after 1/1/2020 with SARS-CoV-2 laboratory tests or diagnostic codes. Detailed electronic medical records are centrally gathered and data harmonized across health care organizations (34 sites). COVID-19 positivity was defined by a positive RT-PCR or antibody testing . HIV infection was defined based on standard diagnostic codes within 2 years prior to COVID-19 testing. Patient characteristics by COVID-19 positive and HIV status were compared using 2 tests. Results: Over 2.1 million patients were captured in the N3C as of 11/25/2020, of whom 292,226 (13.6%) were COVID-19 positive;11,011 (0.5%) were PLWH of whom 1341 (12.2%) tested COVID-19 positive . Compared to HIV-negative patients with COVID-19, COVID-19-positive PLWH were more likely to be 45+ years of age (62.3% vs.43.8%, p<0.001), male (70% vs. 46%, p<0.001), treated on an outpatient basis (9% vs. 5%, p<0.001), and have a modified Charlson comorbidity index score ≥3 (80% vs. 10%,p<0.001). Non-Hispanic (NH) Black COVID-19 positive adults were more likely to have HIV (51% vs. 17%, p<0.001), whereas NH-White were less likely (24% vs. 47%, p<0.001) (Figure 1). When comparing to PLWH without COVID-19, PLWH with COVID-19 were less likely to have a modified Charlson comorbidity index score of 3 or above (27% vs. 32%, p<0.001), with no significant differences in age or sex. COVID-19 positive PLWH were more likely to be NH-Black (51% vs. 45%, p<0.001) and Hispanic (8% vs. 5%, p<0.001), and, conversely, less likely to be NH-White (24% vs. 36%, p<0.001 ) when compared to PLWH without COVID-19 (Figure 1). Conclusion: Racial/ethnic minorities, including NH-Black and Hispanic adults, are disproportionately affected by COVID-19 pandemic, including PLWH. Our ongoing analyses will shed light on underlying mechanisms, such as types of comorbidities, that may lead to racial/ethnic disparities in the concurrence of HIV and COVID-19 positivity in the US.
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Introduction: The COVID-19 pandemic has affected the mental health of adults in the United States (U.S.) due to recommended preventive behaviors such as social distancing. Our objective was to evaluate mental health symptoms and determinants of mental health symptoms among cancer survivors during the COVID-19 pandemic in the U.S. Methods: We used nationally-representative data of 10,760 U.S. adults from the COVID-19 Impact Survey. We defined cancer survivors as a self-reported diagnosis of cancer (n 854, 7.6%). We estimated the association of mental health symptoms among cancer survivors using multinomial logistic regression and calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). We estimated determinants of experiencing at least one mental health symptom 3-7 times in the last seven days among cancer survivors using Poisson regression models to estimated adjusted prevalence ratios (aPR) and 95% CI. Results: Most cancer survivors were over the age of 60 (65%), NH-White (74%), female (52%), and married or living with a partner (57%). Among cancer survivors who spoke to their neighbors basically every day prior to the start of the COVID-19 pandemic, 62% continued this behavior, and 34% reported to speak to their neighbors only a few times a week in the last month. Among cancer survivors, 16% felt depressed, 14% felt lonely, and 13% felt hopeless about the future in the last seven days. Cancer survivors were more likely to report feeling nervous, anxious or on edge (aOR:1.42, 95% CI: 1,07-1.90), depressed (aOR:1.69, 95% CI: 1.28-2.24), lonely (aOR:1.47, 95% CI: 1.09-1.98), and hopeless (aOR:1.55, 95% CI: 1.14-2.10) 3-7 days per week in the last seven days when compared to adults without cancer. Among cancer survivors, adults aged 30-44 years (aPR: 1.87, 95% CI: 1.18-2.95), females (aPR:1.55, 95% CI: 1.12-2.13), without a high school degree (aOR: 1.79, 95% CI;1.05-3.04), and adults with limited social interaction (aPR:1.40, 95% CI: 1.01-1.95) were more likely to experience mental health symptoms 3-7 days/week in the last week. Conclusions: Cancer survivors are experiencing mental health symptoms during the COVID-19 pandemic, particularly young adults, adults without a high school degree, females, and survivors with limited social support.
ABSTRACT
Background: Cancer survivors are at high risk of contracting severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), the infection that leads to COVID-19, as they are generally older and cancer therapies frequentlylead to immunosuppression. Recently, to mitigate exposure the CDC recommended avoiding nonessential doctorappointments, which may lead to barriers in effective continuity of care and surveillance of cancer survivors duringthe COVID-19 pandemic. The patterns of COVID-19 preventive behaviors practiced by cancer survivors areunknown, including practices related to canceling doctors' appointments. Objective: Our objective was to evaluate COVID-19-related preventive behaviors among cancer survivors in theUnited States (US). We further examined behaviors related to canceling or postponing activities, specifically doctors'appointments. Methods: We utilized nationally representative weighted data from a sample of 4,428 US adults from the COVID-19Impact Survey collected during Week 1 (April 20-26, 2020) and Week (May 4-10, 2020). We defined cancersurvivors as those with a self-reported prior diagnosis of cancer. We presented frequencies and used χ2 tests tocompare COVID-19-related preventive behaviors among cancer survivors to other adults. We calculated prevalenceratios with 95% confidence intervals using Poisson regression and robust estimation of standard errors to estimatedeterminants of canceling doctors' appointments among cancer survivors. Results: Cancer survivors were mostly over the age of 60 years (62%), female (53%), non-Hispanic White (62%), and resided in urban areas (72%). Cancer survivors adhered to most recommended COVID-19-related preventivebehaviors and were more likely to maintain social distancing (92%, χ2 p-value=0.005), wear a face mask (89%, χ2p-value=0.001), and avoid crowded areas (84%, χ2 p-value=0.048) compared to other adults. Additionally, we foundthat cancer survivors are more likely to cancel their doctors' appointments (44%, χ2 p-value=0.001) whereas they were less likely to cancel other social activities such as work (20%, χ2 p-value=0.001) and school-related (12%, χ2p-value=0.002) activities, even among those below the age of 60. However, cancer survivors were more likely toreport symptoms in the last 7 days, including muscle or body aches (χ2 p-value=0.003). The proportion of cancerpatients who have canceled doctors' appointments due to COVID-19 rose from the month of April (35%) to May(52%). Younger adults aged 18-29 years, females, and rural cancer survivors were more likely to cancel theirdoctors' appointments, whereas NH-Blacks are less likely to cancel a doctor's appointment when compared to NH-Whites. Conclusion: Cancer survivors are adhering to recommended preventive behaviors. Cancer survivors' continuity ofcare may be impacted by COVID-19, specifically young adults, females, and rural residents.