Original Title: État des pratiques - Portrait des personnes avec antécédent de cancer infectées par le SRAS-CoV-2 durant les deux premières vagues de la pandémie

Authors' objectives: Approximately 300,000 people in Québec were infected with SARS-CoV-2 during the first two waves of the pandemic, and more than 10,000 died after developing COVID-19. People with cancer may be more vulnerable to a severe form of COVID-19 disease because of the frequent presence of other, underlying chronic diseases, these patients’ often advanced age, and possible immunocompromise due to their cancer or treatments. The overall objective of this project was to develop a profile of SARS-CoV-2-infected individuals with cancer or who had had cancer during the previous few years.

Authors' results and conclusions: RESULTS: First, descriptive analyses aimed at characterizing the sociodemographic and clinical differences between infected individuals with and those without a history of cancer were performed. Next, multivariate analyses adjusted for certain clinically relevant variables were performed to estimate the relative risks of hospitalization and death following SARS-CoV-2 infection. The results suggest the following findings: • 298,913 people in Québec were infected with SARS-CoV-2 during the first two waves of the pandemic (March 1, 2020 to March 20, 2021). • Of those infected, 4.4% (slightly more than 13,000) had cancer or had had it during the previous 5 years. • There were considerable sociodemographic differences between those with and those without a history of cancer. Proportionally, infected individuals with a history of cancer were older, more likely to be living in a residence ([CHSLD [residential and long-term care centre], RPA [private seniors’ residence], IR [intermediate resource] or RTF [family-type resource]) and had more comorbidities than infected individuals without a history of cancer. • These differences were observed for the first two waves of the pandemic. However, those infected during the second wave were generally younger, were more likely to be living at home, and had fewer comorbidities, especially those without a history of cancer. • Close to 30% (3847) of the individuals with a history of cancer were hospitalized, and 16.5% (2167) died as a result of SARS-CoV-2 infection. Comparison of the risk of hospitalization and death in SARS-CoV-2 infected individuals after adjustment for certain variables: • A history of cancer significantly increased the risk of hospitalization and death, particularly in individuals with a recent history of cancer (≤ 1 year), for whom these risks were 1.8- and 2.4-fold higher, respectively, than in individuals without a history of cancer. • However, age was the determining variable for the course of the infection, with a 4-fold and 40-fold higher risk of hospitalization and death, respectively, in those aged 90 years and older (compared with those aged 50 to 59 years). • A history of cancer was also associated with an increased risk of ICU admission. However, among hospitalized individuals, those with a history of cancer were not more likely to be admitted to the ICU than those without a history of cancer, probably because of incompatible clinical parameters or personal or therapeutic decisions. • The increased risk of hospitalization and death associated with a history of cancer was observed in most of the subgroups of patients studied. However, it is noted that there was little or no difference in the risk between individuals with and those without a history of cancer for those who were already at high risk, i.e., those over 90 years of age, with a significant number of comorbidities, or living in certain types of residences. Compared to individuals without a history of cancer: • Those with a history of lung or central nervous system cancer, leukemia or nonHodgkin's lymphoma were at higher risk for hospitalization (1.6 to 2.1) and death (2.1 to 3.6). • Those with a history of prostate, kidney, colorectal, ENT or bladder cancer were at moderately higher risk for hospitalization (1.2 to 1.3) and death (1.2 to 1.6). • Those with a history of breast, uterine or thyroid cancer or melanoma were not at greater risk for hospitalization or death. Factors associated with COVID-19-related hospitalization and death in individuals with a history of cancer: • Age was the factor most strongly associated with the risk of hospitalization and death in people with a history of cancer. Compared to persons aged 50 to 59 years, the adjusted relative risk of hospitalization was close to 3-fold higher in persons aged 70 to 79 years, and the risk of death was close to 6-fold higher in those aged 90 years and older. • The risks of hospitalization and death gradually increased with the number of comorbidities. • Individuals treated for cancer during the three months prior to infection were at significantly higher risk for hospitalization and death. • With regard to the types of treatment received during these three months, the highest risks of hospitalization and death were associated with the administration of infused systemic therapy (chemotherapy or immunotherapy) or radiation therapy, probably because of the effect of these treatments on the immune system. Surgery during these three months was also associated with a higher risk of hospitalization, but not with a higher risk of death. All-cause mortality during the COVID-19 pandemic period: • After adjustment for age and sex, the death rate increased by 10.1% in 2020 from the previous year in individuals without a history of cancer and by 3.4% in those with a history of cancer. It is noted, however, that the baseline mortality rate (before or during the pandemic) was about 13-fold higher in individuals with a history of cancer than in those without a history of cancer. CONCLUSION: After adjustment for certain variables, it is seen that a history of cancer increased the risk of COVID-19-related hospitalization and death. The cancer-related risk was observed in all the subgroups analyzed, except individuals already at high risk (e.g., those aged 90 years and older). The higher risk of hospitalization and death varied according to the type of cancer. Lung and central nervous system cancers, non-Hodgkin's lymphoma and leukemia were associated with the highest risks. Of the variables that influenced the risk of hospitalization and death in SARS-CoV-2-infected persons with a history of cancer, age and the number of comorbidities were the most important determinants of the course of the disease. Cancer treatment during the three months prior to infection, particularly infused systemic therapy (chemotherapy or immunotherapy) or radiation therapy, was associated with a higher risk of hospitalization and death. An exploratory analysis found that excess mortality occurred in 2020. It was more modest in individuals with a history of cancer, probably because of a higher baseline risk of death. Even if, compared to other factors, such as age, the risk value associated with cancer was moderately high and the risk was not uniform, overall, individuals with cancer constituted a population that was more vulnerable to the progression of SARS-CoV-2 infection to a more severe form.

Authors' methods: A retrospective cohort study of SARS-CoV-2-infected individuals was carried out using Québec’s clinical administrative databases. The cohort was matched with a cohort of individuals with a history of cancer during the previous five years. This cohort was created with the aid of a newly developed algorithm based on the use of the clinical administrative databases (CADs). The analysis period consisted of the first two waves of the pandemic, defined as March 1, 2020 to March 20, 2021.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/portrait-des-personnes-avec-antecedent-de-cancer-infectees-par-le-sras-cov-2-durant-les-deux-premieres-vagues-de-la-pandemie.html

Year Published: 2022

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/portrait-des-personnes-avec-antecedent-de-cancer-infectees-par-le-sras-cov-2-durant-les-deux-premieres-vagues-de-la-pandemie.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec