Association of Cancer History with COVID-19 Risk and Outcomes among Older Postmenopausal Women: Results from the Women's Health Initiative

Abstract

Background: Several studies early in the COVID-19 pandemic suggested that those with a cancer history had a higher risk of COVID-19 infections and complications. However, few prospective studies evaluated the association of cancer with COVID-19 in older women. We aimed to examine the association of cancer history with the risk of COVID-19 and various COVID-19 outcomes among older women.

Methods: The Women's Health Initiative is an ongoing cohort study that recruited 161,808 postmenopausal women of 50 to 79 years of age from 1993 to 1998. Those who completed the COVID-19 survey (2021-2022) were included (n = 35,623). Multivariable linear and logistic regressions were used to examine COVID-19 positivity, symptom severity, long COVID, and COVID concerns/anxiety outcomes.

Results: Twenty-eight percent (n = 9,901) of participants had a history of cancer. Cancer history was not significantly associated with COVID-19 positivity [OR = 0.94; 95% confidence interval (CI), 0.81-1.08], COVID-19 hospitalization (OR = 1.21; 95% CI, 0.85-1.72), number of symptoms (least squares mean = 0.33; 95% CI, -0.20 to 0.85), and long COVID (OR = 1.18; 95% CI, 0.88-1.58).

Conclusions: A history of cancer was not associated with most COVID-19 outcomes. Future studies should continue to examine physiologic mechanisms contributing to differences among cancer survivors and prioritize the inclusion of underserved populations to identify strategies to address the impact of COVID-19.

Impact: These findings may assure cancer survivors that their diagnosis alone does not increase their risk of COVID-19 and suggest that older women with a history of cancer may have similar risks of COVID-19 outcomes compared with their noncancer counterparts.