High Risk and Severity of COVID-19 Shown in Four Cancer Subgroups

In an interview with Targeted Oncology, Clara Hwang, MD, discussed how real-world evidence uncovered multiple disparities related to COVID-19 and patients with cancer.

Since the start of the coronavirus disease 2019 (COVID-19) pandemic oncologists have stated that patients with cancer are at an increased risk for contracting the virus. New research using real-world data shows that these patients are also more likely to have severe COVID-19-related complications and not survive.

The study, which was conducted by using clinical data from 2 large healthcare systems in the Midwest, also revealed a higher risk of COVID-19 complications and death based on the severity of cancer, race, age, and socioeconomic status. The research was published recently in Cancer Reports.

Based on these findings, investigators led by Clara Hwang, MD, concluded the real-world research can be utilized to provide a better understanding of patient outcomes and how their demographics impact outcome, especially during times of urgent healthcare challenges.

In an interview with Targeted OncologyTM, Hwang, a medical oncologist and senior staff physician at the Henry Ford Health System, discussed how real-world evidence uncovered multiple disparities related to COVID-19 and patients with cancer.

TARGETED ONCOLOGY™: Can you explain how this study came about?

HWANG: Early reports suggested that COVID-19 risk were higher both for cancer patients, as well as for Black Americans. So, we hoped to understand which patients were at the highest risk of developing and being diagnosed with COVID-19, as well as getting complications. This also maybe why those patients were at increased risk for COVID-19. And one of the things we wanted to add to that was also an investigation of how socioeconomic factors might play into that.

What are the goals of this study?

First, we want to identify which risk factors were associated with being diagnosed with COVID-19. So, we were looking specifically at patients in our system that were diagnosed with cancer. Then, for patients with cancer who were diagnosed with COVID-19, we want to know which factors are associated with worse outcomes, such as requiring ventilatory support, or of course, dying of COVID-19.

Can you explain the findings from this study?

Looking at our cancer population, both Black American patients as well as patients who lived in zip codes where the median income was less than $30,000, those patients were at higher risk of being diagnosed with COVID-19. For both of those groups, the risk was about 3 times higher. In addition, patients who were living in those zip codes with a median income of less than $30,000, as well as Black patients with cancer, they were at the highest risk of having severe COVID-19 effects or dying of COVID-19.

When looking at other conditions, similar to patients who don't have cancer, patients who have comorbidities such as diabetes and hypertension, were at increased risk of being diagnosed with COVID-19. They were also more vulnerable to the effects of COVID-19 complications.

We found that risk of dying of a COVID-19 was independently associated with the patients who are elderly, as well. Certain comorbidities played a role. Patients who have active cancer defined as either having received a diagnosis of cancer in the past year, or cancer treatment in the past year, were more likely to develop COVID-19 as well as to develop complications. Specifically, recent cancer treatments, such as chemotherapy or immunotherapy, at least in our study, were found to have an independently increased risk for dying of COVID-19.

What was surprising about these results?

I do think it was very important that we found an increased risk of developing COVID-19 as well as COVID-19 complications and our Black American patients as well as patients in zip codes with low median household incomes. I think it really highlights vulnerable patient populations that we need to be more attentive to and to see what we can do to try to mitigate those risks. In addition, we do know that cancer is a disease where a lot of our therapies do cause patients to become immunocompromised and again, that is another patient population at increased risk of COVID-19 complications.

This research reaffirms the power of real-world data. How do think oncologists can use this information in every-day practice?

In terms of real-world data, I do think that this really highlights how we can rapidly identify patients at risk for both getting COVID-19 as well as COVID-19 complications, especially with the use of electronic health records.

In terms of what oncologists can do in everyday practice, I think, just being reminded of these vulnerable patient populations is key. We know that patients with comorbidities, elderly patients, and especially patients who've had recent cancer therapy, such as chemotherapy or immunotherapy are at an increased risk of developing complications from COVID-19. So, I think what we can do for those patients is to protect them, and that involves things that we can do in our own practices, as well as recommendations that we can give to our patients.

Based on what was observed in your cohort, what can physicians do to lower the mortality rate among these at-risk patients?

I think the most important tool we have currently is vaccination. I think we should, of course, encourage our patients to get vaccinated. In addition, I think we should also encourage vaccination in people who have contact with our cancer patients. And so that, of course, includes our health care team. I'm very proud that Henry Ford has mandated vaccination for all our health care workers as well as our staff. I think that's an important thing to accomplish.

We do know that vaccination responses may be inadequate in our cancer patients because of they have compromised immune status. For that reason, I think doing everything we can to protect them is important. Also, mass social distancing is still important to try to minimize the COVID transmission.

What are the key points you want oncologists to take away from this research?

Sometimes our patients have specific questions. I think counseling them about the fact that patients who have active cancer are more at increased risk is key. Maybe if a patient’s cancer is in remission, and it was diagnosed a long time ago, those risks may not be as high as for someone who is on active treatments, such as chemotherapy. The other thing is just a reminder of how race and socioeconomic status can affect the risk of developing COVID-19 as well as complications. We as a society must remember that there are these vulnerable patient populations, and to try to do what we can as a society to try to mitigate those risks.


Hwang C, Izano MA, Thompson MA, et al. Rapid real-world data analysis of patients with cancer, with and without COVID-19, across distinct health systems. Cancer Rep. Published online ahead of print May 2021. doi: 10.1002/cnr2.1388