Available online 19 December 2022, 102318

Author links open overlay panelAbstractBackground

The risks of hospital admission for COVID-19 related conditions and all-cause death of SARS-CoV-2 infected cancer patients were investigated according to vaccination status.

Methods

A population-based cohort study was carried out on 9,754 infected cancer patients enrolled from January 1, 2021 to June 30, 2022. Subdistribution hazard ratio (SHRs) or HRs with 95% confidence intervals (CI), adjusted for sex, age, comorbidity, and time since cancer incidence, were computed to assess the risk of hospital admission and death of unvaccinated vs. patients with at least one dose of vaccine (i.e., vaccinated).

Results

485 unvaccinated patients (25.5%) were at a 2.57 elevated risk of hospital admission (95% CI: 2.13-2.87) and at a 3.50 elevated risk of death (95% CI: 3.129-3.85), as compared to vaccinated patients. Significantly elevated hospitalizations and death risks emerged for both sexes, across all age groups and time elapsed since cancer diagnosis. For unvaccinated patients, SHRs for hospitalization were particularly elevated in those with solid tumors (SHR=2.69 vs. 1.66 in hematological patients) while HRs for the risk of death were homogeneously distributed. As compared to boosted patients, SHRs for hospitalization and HRs for death increased with decreasing number of doses.

Conclusions

Study findings stress the importance of SARS-CoV-2 vaccines to reduce hospital admission and death risk in cancer patients.

Introduction

It has been well documented since the early phase of the COVID-19 pandemic that cancer patients with SARS-CoV-2 infection were at increased risk of hospital admission and death, particularly elderly ones, those with major medical comorbidities and those under immunosuppressive anti-cancer therapies [1], [2], [3], [4], [5]. An elevated 30-day mortality was documented on 928 patients with COVID-19 and cancer enrolled in The COVID-19 and Cancer Consortium (CCC19) cohort [5], while among 1557 cancer patients with COVID-19 enrolled in the OnCovid multicenter study, 72.2% of those with sequelae required hospitalization, as compared to 41.2% of those without sequelae [1]. According to early evidence, cancer patients were among the prioritized population groups for vaccination against SARS-CoV-2 infection.

The impact of SARS-CoV-2 infection on clinical outcomes of cancer patients in northeastern Italy was already investigated [2]. In this investigation, we updated the previous analysis by focusing on the impact of SARS-CoV-2 vaccination on infected cancer patients. The study objective was to assess the risk of COVID-19 hospitalization and death in infected cancer patients according to SARS-CoV-2 vaccination status.

Section snippetsStudy design and population

A population-based, cohort study was conducted using data derived from healthcare databases of the Friuli Venezia Giulia region (1,210,000 inhabitants, north-eastern Italy). These health-related databases cover -as previously published [6] - the whole resident population and provide information on patients’ personal data (e.g., sex, birth date, place of residence, vital status) and medical care history (e.g., hospital discharges, outpatient care, histopathological reports, and medical fee

Results

The overall population of 202,621 individuals who tested positive for SARS-CoV-2 infection during the study period included 9,754 (4.8%) individuals with a history of cancer diagnosed before testing (Fig. 1). Among these cancer patients, 7,269 (74.5%) received at least one dose of vaccine, while 2,485 (25.5%) were unvaccinated (Fig. 1). The median follow-up time from positive test to study closure was 250 days among vaccinated, and 262 days among the 2,485 unvaccinated cancer patients.

The

Discussion

It is well documented that SARS-CoV-2 infection and related COVID-19 conditions will negatively impact the clinical outcomes of cancer patients, including hospital admission and death, as compared to the corresponding uninfected patients. Since their availability, the immunogenicity of SARS-CoV-2 vaccines has been demonstrated in the general population and in patients with several cancer sites/types [10], [11], [12]. Such efficacy includes the recent vaccines against the Omicron variant [13],

Funding

This work was supported by Ricerca Corrente Line 2 and Ministry of Health (5×1000 2017 to CRO, Aviano). The funding source had no involvements in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.

Author contributions

All authors substantially contributed to the concept and design of the present study and provided original data. The statistical analyses were carried out by Michele Gobbato and Martina Taborelli; the article was drafted by Michele Gobbato, Diego Serraino, and Martina Taborelli; Elena Clagnan and Stefania Del Zotto were responsible for the management of databases. All authors critically revised the article content and approved the final version submitted for publication.

Declaration of interest

None.

Acknowledgement

The authors thank Mrs Luigina Mei for editorial assistance.

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© 2022 Published by Elsevier Ltd.