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. 2023 Jun 19:38:100824.
doi: 10.1016/j.lanwpc.2023.100824. Online ahead of print.

COVID-19 infection among patients with cancer in Australia from 2020 to 2022: a national multicentre cohort study

Victoria G Hall  1   2 , Beatrice Z Sim  1   2 , Chhay Lim  2 , Christopher Hocking  3 , Teddy Teo  4 , Naomi Runnegar  5 , Peter Boan  6 , Christopher H Heath  6   7 , Natalie Rainey  8 , Megan Lyle  8 , Christopher Steer  9 , Eunice Liu  10 , Cassandra Doig  10 , Kate Drummond  11 , Patrick G P Charles  11 , Katharine See  12 , Lyn-Li Lim  13 , Omar Shum  14 , Narin Bak  15 , Sue-Anne Mclachlan  16   17 , Kasha P Singh  18 , Nicholas Laundy  2 , Jenny Gallagher  2 , Marcelle Stewart  2 , Natalie R Saunders  2 , Emily Klimevski  2 , Jessica Demajo  2 , Gemma Reynolds  1   2 , Karin A Thursky  1   2 , Leon J Worth  1   2 , Timothy Spelman  19   20 , Michelle K Yong  1   2   21 , Monica A Slavin  1   2   21 , Benjamin W Teh  1   2
Affiliations

COVID-19 infection among patients with cancer in Australia from 2020 to 2022: a national multicentre cohort study

Victoria G Hall et al. Lancet Reg Health West Pac. .

Abstract

Background: The global COVID-19 pandemic disproportionately affected certain populations and its management differed between countries. This national study describes characteristics and outcomes of COVID-19 in patients with cancer in Australia.

Methods: We performed a multicentre cohort study of patients with cancer and COVID-19 from March 2020 to April 2022. Data were analysed to determine varying characteristics between cancer types and changes in outcomes over time. Multivariable analysis was performed to determine risk factors associated with oxygen requirement.

Findings: 620 patients with cancer from 15 hospitals had confirmed COVID-19. There were 314/620 (50.6%) male patients, median age 63.5 years (IQR 50-72) and majority had solid organ tumours (392/620, 63.2%). The rate of COVID-19 vaccination (≥1 dose) was 73.4% (455/620). Time from symptom onset to diagnosis was median 1 day (IQR 0-3), patients with haematological malignancy had a longer duration of test positivity. Over the study period, there was a significant decline in COVID-19 severity. Risk factors associated with oxygen requirement included male sex (OR 2.34, 95% CI 1.30-4.20, p = 0.004), age (OR 1.03, 95% CI 1.01-1.06, p = 0.005); not receiving early outpatient therapy (OR 2.78, 95% CI 1.41-5.50, p = 0.003). Diagnosis during the omicron wave was associated with lower odds of oxygen requirement (OR 0.24, 95% CI 0.13-0.43, p < 0.0001).

Interpretation: Outcomes from COVID-19 in patients with cancer in Australia over the pandemic have improved, potentially related to changing viral strain and outpatient therapies.

Funding: This study was supported by research funding from MSD.

Keywords: COVID-19; Severity; Treatment; Vaccination.

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Conflict of interest statement

VGH is supported by an Australian Government National Health and Medical Research Council (NHMRC) post-graduate PhD scholarship (#2014210). BZS has received support from the Fred Hutch Symposium for conference attendance. TT has received honoraria and conference support from Pfizer. CS has sat on advisory boards for MSD, Ipsen, Roche, Astra Zeneca, Sanofi, Janssen and GSK and accepted speaker fees from BMS, Eisai and Novartis. MY has received honorarium from MSD and Takeda. TS has received compensation for serving on scientific advisory boards, honoraria for consultancy and funding for travel from Biogen. MAS has been on data safety monitoring and adjudication committees for Cidara, Roche and Pfizer. She has received research funding from Gilead Sciences, Merck, F2G and sat on advisory boards for Gilead Sciences, F2G, Cidara, Takeda and Merck. MAS is supported by Australian Government National Health and Medical Research Council Investigator (#1173791) and Synergy Grants (#2011100). BWT has been on the advisory board for Moderna, Takeda and CSL-Behring and received research funding from MSD and Seqirus. BWT has received honoraria paid to the institution from Pfizer, Alexion and Janssen. BWT is supported by the Australian Government Medical Research Future Fund Investigator Fellowship (EL-2, #1195894). All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Frequency of COVID-19 over the study period, by vaccination status. Over the study period, there were n = 455 vaccinated patients (n = 455) and n = 105 unvaccinated patients who developed COVID-19. Vaccinated patients included any patient who had received 1 or more doses of an approved SARS-CoV-2 vaccine and a confirmed SARS-CoV-2 infection more than 14 days after the first vaccine dose. Unknown vaccination status was excluded from this figure (n = 60). The x-axis represents days since Jan. 1, 2020, and the y-axis represents the number of patients diagnosed with COVID-19. The study period concluded on April 30, 2022. The different “waves” of COVID-19 as well as the dominant SARS-CoV-2 variant (if applicable) are represented at the appropriate timepoints with corresponding dates during the study period.
Fig. 2
Fig. 2
COVID-19 severity outcomes over time. A chi-square test was applied for the longitudinal analysis to compare the frequency of each measure of COVID-19 severity during 2020 vs 2021 vs 2022. The x axis indicates the study period time (year of COVID-19 diagnosis) and the y axis indicates the percentage of the cohort with the event during each time period.
See this image and copyright information in PMC

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