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Comment
. 2025 Sep 1;11(9):990-998.
doi: 10.1001/jamaoncol.2025.2010.

Risk Factors for COVID-19-Related Hospitalization and Death in Patients With Cancer: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS)

Brian I Rini  1 , Ana F Best  2 , Mel D Bowman  3 , Grace E Mishkin  4 , Andrea M Denicoff  4 , Larry V Rubinstein  2 , Lyndsay Harris  4 , Ann M Geiger  5 , Nicholas M Mark  6 , Steven A Pergam  7 , Jeremy L Warner  8   9 , Alok A Khorana  10 , Sacha Gnjatic  11 , Tina W F Yen  12 , Darla K Liles  13 , Christine M Bestvina  14 , Neil J Shah  15 , Jacqueline T Norrell  16 , Dawn L Hershman  17 , Jennifer L Holter-Chakrabarty  18 , Andrew S Poklepovic  19 , Stephen J Chanock  20 , Hari Sankaran  2 , Larissa A Korde  4
Affiliations
Comment

Risk Factors for COVID-19-Related Hospitalization and Death in Patients With Cancer: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS)

Brian I Rini et al. JAMA Oncol. .

Abstract

Importance: Retrospective case series have identified having cancer and receiving treatment for cancer as risk factors for inferior COVID-19 outcomes.

Objective: To determine risk factors for hospitalization and death in patients with cancer with COVID-19 infection.

Design, setting, and participants: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) is a prospective longitudinal natural history cohort study examining the impact of COVID-19 on patients with cancer. Adults were eligible within 14 days of an initial positive SARS-CoV-2 test result if they were receiving active treatment for cancer or had prior stem cell/bone marrow transplant or CAR T-cell treatment. The statistical analysis took place between September 2024 and April 2025.

Main outcomes and measures: The primary objective of the study was to determine patient factors, therapy types, and cancer types associated with COVID-19 severity, defined as hospitalization for or death from COVID-19 within 30 and 90 days after the first positive SARS-CoV-2 test result. Multivariable regressions were performed for COVID-19-specific hospitalization and mortality (proportional hazard and cause-specific hazard models).

Results: Of 1572 eligible adult patients (median [range] age, 60 [18-93] years; 840 female [53.4%]), 1066 (67.8%) had a solid tumor, with 683 (64.0%) having metastatic disease; breast (252 [23.6%]) and lung cancer (148 [13.9%]) were most common. At enrollment, 1013 patients (64.4%) were unvaccinated for SARS-CoV-2. COVID-19-related mortality at 90 days was 3.0% and did not increase at subsequent time points. The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers. In multivariable analysis, receipt of chemotherapy (hazard ratio [HR], 1.97; 95% CI, 1.52-2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR, 1.78; 95% CI, 1.33-2.38) were associated with a higher risk of hospitalization. Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70). Over 2 years of follow-up, there were 1739 cancer treatment disruptions, of which 881 (50.7%) were attributed to COVID-19, with most disruptions occurring within the first 30 days.

Conclusions and relevance: The results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rini reported grants and personal fees from Merck; grants from Arcus, AVeo, BMS, and Adela; participation in the data safety monitoring board for AstraZeneca; and personal fees from Formedica and Eisai outside the submitted work. Dr Pergam reported support from F2G, Symbio, and Mundipharma to their institution for participating in clinical trials outside the submitted work. Dr Warner reported grants from the National Institutes of Health, American Association for Cancer Research, and Brown Physicians Inc, personal fees from Westat and The Lewin Group, and nonfinancial support from HemOnc.org LLC outside the submitted work. Dr Khorana reported personal fees from Anthos, BMS, Pfizer, Med Learning Group, Regeneron, and Sanofi outside the submitted work. Dr Gnjatic reported grants from Regeneron, Boehringer-Ingelheim, Takeda, Celgene, and Janssen and personal fees from Taiho Pharmaceuticals outside the submitted work. Dr Bestvina reported grants from AstraZeneca and BMS and personal fees from AbbVie, Amgen, AstraZeneca, BMS, Daiichi, EMD Serono, Genentech, Gilead, Guardant, J&J, Mirati, Novocure, Pfizer, Sanofi, Tempus, and Turning Point Therapeutics outside the submitted work. Dr Shah reported personal fees from Merck and grants from Exelixis and HiberCell outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) Flow Diagram
Figure 2.
Figure 2.. Percentage of Patients Receiving COVID-19 Therapy Within 30 Days of Initial Positive SARS-CoV-2 Test Result
Spline methods are described in Supplement 1.
Figure 3.
Figure 3.. Death and Hospitalization Outcomes After Initial Positive SARS-CoV-2 Test Result
The shaded areas in panel A represent 95% CIs. Risk tables for all panels are provided in Supplement 1.
Figure 4.
Figure 4.. Cancer Treatment Disruption Outcomes
Patients with 1 or more treatment disruption(s) were included, stratified by whether the disruption was attributed to COVID-19 or if the attribution status was unknown. The 2-week and/or 1-month posttest time points were used for assessments of reason for disruption (B), type of treatment disrupted (C), and type of treatment disruption (D).
See this image and copyright information in PMC

Comment on

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