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Black Patients With Cancer Had Worse COVID-19 Outcomes

“Together these 2 diseases create a perfect storm”: Black people with cancer were more likely to have severe or fatal COVID-19 disease.

The coronavirus pandemic exposed and widened health disparities in marginalized populations. Black individuals are 13% of the US population, yet they account for 20% of COVID-19 infections and 23% of COVID-19-related deaths.

Non-Hispanic Black people have disproportionately high rates of COVID-19 infection, so one study examine whether this was also true in Black patients with cancer. Comorbidities, such as cancer, increase COVID-19 patients’ risk of severe illness and death.

The retrospective cohort study, published yesterday in JAMA, examined the clinical characteristics and disease outcomes of COVID-19 in Black patients with cancer. The study included patients of Black or White race with a current or past cancer diagnosis who tested positive for COVID-19 from March 17-November 18, 2020.

The primary study outcome was a 5-level ordinal scale of COVID-19 severity based upon patients’ disease status. Levels included: 1. None of the complications listed here, 2. Hospital admission, 3. Intensive care unit admission, 4. Mechanical ventilation use, and 5. Death from any cause.

Patient data was collected from the COVID-19 and Cancer Consortium (CCC19) Registry. The cohort study included 3506 patients, of which 50% were women and the average age was 67 years. A total of 30% of patients (n=1038) were Black, and 70% (n=2438) were White.

Black patients had significantly higher rates of comorbidities at the time of COVID-19 diagnosis, including obesity, diabetes, and kidney disease. After adjusting results for comorbidities, cancer type, cancer status, and anticancer therapies at the time of COVID-19 diagnosis, the investigators found Black patients presented with worse illness and had significantly worse COVID-19 outcomes than White patients.

Black patients were more likely than White patients to have moderate (41% vs 34%) or severe (14% vs 11%) COVID-19 disease upon diagnosis. Black cancer patients had higher rates of pulmonary complications, acute kidney injury, and cardiovascular complications. All-cause mortality was 19% in Black patients and 17% in White patients.

“We saw worse COVID-19 illness at presentation, higher rates of hospitalization, higher rates of intensive care unit admission, higher rates of mechanical ventilation and worse death rates in Black patients compared to non-Hispanic white patients, even after making the two groups comparable in terms of type, status and treatment of cancer by statistical analysis methods,” said Dimpy Shah, MD, PhD, assistant professor of population health sciences at The University of Texas Health Science Center at San Antonio and an author of the study.

Notably, the investigators identified differences in the treatments given to Black versus White COVID-19 patients with cancer. Hydroxychloroquine was prescribed more to Black patients, while White patients were more likely to be given remdesivir. Remdesivir is an antiviral widely indicated to treat COVID-19 in adults and children over 12, while hydroxychloroquine is a malaria drug. The US Food and Drug Administration (FDA) rescinded its Emergency Use Authorization (EUA) of hydroxychloroquine to treat COVID-19 after data showed it to be ineffective.

“Some of the societal root causes of health disparities, including lack of access to health care, social determinants of health, preexisting comorbidities and access to clinical research, are common to both cancer and COVID-19, and together these two diseases create a perfect storm,” Shah said.