ABSTRACT
The aim of this population-based study was to evaluate the impact of having had cancer on COVID-19 risk and prognosis during the first wave of the pandemic (27 February - 13 May 2020) in Reggio Emilia Province. Prevalent cancer cases diagnosed between 1996 and December 2019 were linked with the provincial COVID-19 surveillance system. We compared cancer survivors (CS) cumulative incidence of being tested, testing positive for SARS-CoV-2, being hospitalized, and dying of COVID-19 with that of the general population; we compared COVID-19 prognosis in CS and in patients without cancer. 15,391 people (1527 CS) underwent RT-PCR for SARS-CoV-2, of whom 4541 (447 CS) tested positive; 541 (113 CS) died of COVID-19. The cumulative incidences of being tested, testing positive, COVID-19 hospitalization, and death were lower in CS: age- and sex-adjusted incidence rate ratios were 1.28 [95%CI = 1.21, 1.35], 1.06 [95%CI = 0.96, 1.18], 1.27 [95%CI = 1.09, 1.48], and 1.39 [95%CI = 1.12, 1.71], respectively. CS had worse prognosis when diagnosed with COVID-19, particularly those below the age of 70 (age- and sex-adjusted odds ratio (OR) of death 5.03; [95%CI = 2.59, 9.75]), while the OR decreased after age 70. The OR of death was higher for patients with a recent diagnosis, i.e. <2 years (OR=2.92; 95%CI = 1.64, 5.21), or metastases (OR=2.09; 95%CI = 0. 88, 4.93). Cancer patients showed the same probability of being infected, despite a slightly higher probability of being tested, than the general population, nevertheless they were at higher risk of death once infected. Novelty and impactCancer survivors during the first wave of the pandemic showed higher COVID-19 cumulative incidence and mortality. When infected, they had worse prognosis, particularly in people younger than age 70 or those with a recent diagnosis.
