Association of COVID-19 Vaccination With Breakthrough Infections and Complications in Patients With Cancer.
JAMA Oncol
; 9(3): 386-394, 2023 03 01.
Article
in English
| MEDLINE | ID: covidwho-2260946
ABSTRACT
Importance Patients with cancer are known to have increased risk of COVID-19 complications, including death. Objective:
To determine the association of COVID-19 vaccination with breakthrough infections and complications in patients with cancer compared to noncancer controls. Design, Setting, andParticipants:
Retrospective population-based cohort study using linked administrative databases in Ontario, Canada, in residents 18 years and older who received COVID-19 vaccination. Three matched groups were identified (based on age, sex, type of vaccine, date of vaccine) 14 match for patients with hematologic and solid cancer to noncancer controls (hematologic and solid cancers separately analyzed), 11 match between patients with hematologic and patients with solid cancer. Exposures Cancer diagnosis. Main Outcomes andMeasures:
Outcomes occurring 14 days after receipt of second COVID-19 vaccination dose primary outcome was SARS-CoV-2 breakthrough infection; secondary outcomes were emergency department visit, hospitalization, and death within 4 weeks of SARS-CoV-2 infection (end of follow-up March 31, 2022). Multivariable cumulative incidence function models were used to obtain adjusted hazard ratio (aHR) and 95% CIs.Results:
A total of 289â¯400 vaccinated patients with cancer (39â¯880 hematologic; 249â¯520 solid) with 1â¯157â¯600 matched noncancer controls were identified; the cohort was 65.4% female, and mean (SD) age was 66 (14.0) years. SARS-CoV-2 breakthrough infection was higher in patients with hematologic cancer (aHR, 1.33; 95% CI, 1.20-1.46; P < .001) but not in patients with solid cancer (aHR, 1.00; 95% CI, 0.96-1.05; P = .87). COVID-19 severe outcomes (composite of hospitalization and death) were significantly higher in patients with cancer compared to patients without cancer (aHR, 1.52; 95% CI, 1.42-1.63; P < .001). Risk of severe outcomes was higher among patients with hematologic cancer (aHR, 2.51; 95% CI, 2.21-2.85; P < .001) than patients with solid cancer (aHR, 1.43; 95% CI, 1.24-1.64; P < .001). Patients receiving active treatment had a further heightened risk for COVID-19 severe outcomes, particularly those who received anti-CD20 therapy. Third vaccination dose was associated with lower infection and COVID-19 complications, except for patients receiving anti-CD20 therapy. Conclusions and Relevance In this large population-based cohort study, patients with cancer had greater risk of SARS-CoV-2 infection and worse outcomes than patients without cancer, and the risk was highest for patients with hematologic cancer and any patients with cancer receiving active treatment. Triple vaccination was associated with lower risk of poor outcomes.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Hematologic Neoplasms
/
COVID-19
/
Neoplasms
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
/
Vaccines
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Oncol
Year:
2023
Document Type:
Article
Affiliation country:
Jamaoncol.2022.6815
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