Authors

Jessica E Hawley, Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle
Tianyi Sun, Vanderbilt University Medical Center, Nashville, Tennessee
David D Chism, Thompson Cancer Survival Center, Knoxville, Tennessee
Narjust Duma, University of Wisconsin Carbone Cancer Center, Madison
Julie C Fu, Tufts Medical Center Cancer Center, Boston and Stoneham, Massachusetts
Na Tosha N Gatson, Geisinger Health System, Danville, Pennsylvania; Banner MD Anderson Cancer Center, Gilbert, Arizona
Sanjay Mishra, Vanderbilt University Medical Center, Nashville, Tennessee
Ryan H Nguyen, University of Illinois Hospital & Health Sciences System, Chicago
Sonya A Reid, Vanderbilt University Medical Center, Nashville, Tennessee
Oscar K Serrano, Hartford HealthCare Cancer Institute, Hartford, Connecticut
Sunny R K Singh, Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
Neeta K Venepalli, University of North Carolina, Lineberger Cancer Center, Chapel Hill
Ziad Bakouny, Dana-Farber Cancer Institute, Boston, Massachusetts
Babar Bashir, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
Mehmet A Bilen, Winship Cancer Institute of Emory University, Atlanta, Georgia
Paolo F Caimi, Case Comprehensive Cancer Center at Case Western Reserve University/University Hospitals, Cleveland, Ohio
Toni K Choueiri, Dana-Farber Cancer Institute, Boston, Massachusetts
Scott J Dawsey, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
Leslie A Fecher, University of Michigan Rogel Cancer Center, Ann Arbor
Daniel B Flora, St Elizabeth Healthcare, Edgewood, Kentucky
Christopher R Friese, University of Michigan Rogel Cancer Center, Ann Arbor
Michael J Glover, Stanford Cancer Institute at Stanford University, Palo Alto, California
Cyndi J Gonzalez, University of Michigan Rogel Cancer Center, Ann Arbor
Sharad Goyal, George Washington University, Washington, DC
Thorvardur R Halfdanarson, Mayo Clinic, Rochester, Minnesota
Dawn L Hershman, Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
Hina Khan, Brown University and Lifespan Cancer Institute, Providence, Rhode Island
Chris Labaki, Dana-Farber Cancer Institute, Boston, Massachusetts
Mark A Lewis, Intermountain Healthcare, Salt Lake City, Utah
Rana R McKay, University of California, San Diego
Ian Messing, George Washington University, Washington, DC
Nathan A Pennell, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
Matthew Puc, Virtua Health, Marlton, New Jersey
Deepak Ravindranathan, Winship Cancer Institute of Emory University, Atlanta, Georgia
Terence D Rhodes, Intermountain Healthcare, Salt Lake City, Utah
Andrea V Rivera, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
John Roller, University of Kansas Medical Center, Kansas City
Gary K Schwartz, Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
Sumit A Shah, Stanford Cancer Institute at Stanford University, Palo Alto, California
Justin A Shaya, University of California, San Diego
Mitrianna Streckfuss, Advocate Aurora Health, Milwaukee, Wisconsin
Michael A Thompson, Advocate Aurora Health, Milwaukee, Wisconsin
Elizabeth M Wulff-Burchfield, University of Kansas Medical Center, Kansas City
Zhuoer Xie, Mayo Clinic, Rochester, Minnesota
Peter Paul Yu, Hartford HealthCare Cancer Institute, Hartford, Connecticut
Jeremy L Warner, Vanderbilt University Medical Center, Nashville, Tennessee
Dimpy P Shah, Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, Texas
Benjamin French, Vanderbilt University Medical Center, Nashville, Tennessee
Clara Hwang, Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan

Document Type

Article

Publication Date

1-4-2022

Comments

This article is the author's final published version in JAMA Network Open, Volume 5, Issue 1, January 2022, Article number e2142046.

The published version is available at https://doi.org/10.1001/jamanetworkopen.2021.42046.

Copyright © 2022 Hawley JE et al. JAMA Network Open

This is an open access article distributed under the terms of the CC-BY License.

Abstract

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography.

Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer.

Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States.

Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index.

Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time.

Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58).

Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

34982158

Language

English

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