Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States
Authors: Jessica E. Hawley, Tianyi Sun, David D. Chism, Narjust Duma, Julie C. Fu, Na Tosha N. Gatson, Sanjay Mishra, Ryan H. Nguyen, Sonya A. Reid, Oscar K. Serrano, Sunny R. K. Singh, Neeta K. Venepalli, Ziad Bakouny, Babar Bashir, Mehmet A. Bilen, Paolo F. Caimi, Toni K. Choueiri, Scott J. Dawsey, Leslie A. Fecher, Daniel B. Flora, Christopher R. Friese, Michael J. Glover, Cyndi J. Gonzalez, Sharad Goyal, Thorvardur R. Halfdanarson, Dawn L. Hershman, Hina Khan, Chris Labaki, Mark A. Lewis, Rana R. McKay, Ian Messing, Nathan A. Pennell, Matthew Puc, Deepak Ravindranathan, Terence D. Rhodes, Andrea V. Rivera, John Roller, Gary K. Schwartz, Sumit A. Shah, Justin A. Shaya, Mitrianna Streckfuss, Michael A. Thompson, Elizabeth M. Wulff-Burchfield, Zhuoer Xie, Peter Paul Yu, Jeremy L. Warner, Dimpy P. Shah, Benjamin French, Clara Hwang, Balazs Halmos, Amit K. Verma, Benjamin A. Gartrell, Sanjay Goel, Nitin Ohri, R.Alejandro Sica, Astha Thakkar, Keith E. Stockerl-Goldstein, Omar Butt, Jian L. Campian, Mark A. Fiala, Jeffrey P. Henderson, Ryan Monahan, Alice Y. Zhou, Michael A. Thompson, Pamela Bohachek, Daniel Mundt, Mitrianna Streckfuss, Eyob Tadesse, Philip E. Lammers, Orestis A. Panagiotou, Pamela C. Egan, Dimitrios Farmakiotis, Hina Khan, Adam J. Olszewski, Arturo Loaiza-Bonilla, Salvatore A. Del Prete, Michael H. Bar, Anthony P. Gulati, K. M. Steve Lo, Suzanne J. Rose, Jamie Stratton, Paul L. Weinstein, Paolo F. Caimi, Jill S. Barnholtz-Sloan, Jorge A. Garcia, John M. Nakayama, Shilpa Gupta, Nathan A. Pennell, Manmeet S. Ahluwalia, Scott J. Dawsey, Christopher A. Lemmon, Amanda Nizam, Claire Hoppenot, Ang Li, Toni K. Choueiri, Ziad Bakouny, Gabrielle Bouchard, Fiona J. Busser, Jean M. Connors, Catherine R. Curran, George D. Demetri, Antonio Giordano, Kaitlin Kelleher, Anju Nohria, Andrew Schmidt, Grace Shaw, Eli Van Allen, Pier Vitale Nuzzo, Vincent Xu, Rebecca L. Zon, Tian Zhang, Susan Halabi, John C. Leighton, Gary H. Lyman, Jerome J. Graber, Petros Grivas, Ali Raza Khaki, Elizabeth T. Loggers, Ryan C. Lynch, Elizabeth S. Nakasone, Michael T. Schweizer, Lisa Tachiki, Shaveta Vinayak, Michael J. Wagner, Albert Yeh, Na Tosha N. Gatson, Sharad Goyal, Minh-Phuong Huynh-Le, Lori J. Rosenstein, Peter Paul Yu, Jessica M. Clement, Ahmad Daher, Mark Dailey, Rawad Elias, Asha Jayaraj, Emily Hsu, Alvaro G. Menendez, Joerg Rathmann, Oscar Serrano, Clara Hwang, Shirish M. Gadgeel, Sunny R K Singh, Jessica E. Hawley, Dawn Hershman, Melissa K. Accordino, Divaya Bhutani, Gary K. Schwartz, Daniel Y. Reuben, Mariam Alexander, Sarah Mushtaq, Eric H. Bernicker, John Deeken, Danielle Shafer, Mark A. Lewis, Terence D. Rhodes, David M. Gill, Clarke A. Low, Sandeep H. Mashru, Abdul-Hai Mansoor, Howard A. Zaren, Stephanie J. Smith, Gayathri Nagaraj, Mojtaba Akhtari, Eric Lau, Mark E. Reeves, Stephanie Berg, Destry Elms, Alicia K. Morgans, Firas H. Wehbe, Jessica Altman, Michael Gurley, Mary F. Mulcahy, Eric B. Durbin, Amit A. Kulkarni, Heather H. Nelson, Zohar Sachs, Surbhi Shah, Rachel P. Rosovsky, Kerry Reynolds, Aditya Bardia, Genevieve Boland, Justin Gainor, Leyre Zubiri, Thorvardur R. Halfdanarson, Tanios Bekaii-Saab, Aakash Desai, Zhuoer Xie, Ruben A. Mesa, Mark Bonnen, Daruka Mahadevan, Amelie G. Ramirez, Mary Salazar, Dimpy P. Shah, Pankil K. Shah, Bryan Faller, Rana R. McKay, Archana Ajmera, Sharon S. Brouha, Angelo Cabal, Albert Hsiao, Seth Kligerman, Justin A. Shaya, Lisa B. Weissmann, Chinmay Jani, Carey C. Thomson, Jeanna Knoble, Mary Grace Glace, Cameron Rink, Karen Stauffer, Rosemary Zacks, Sibel Blau, Monika Joshi, Harry Menon, Marc A. Rovito, Elizabeth A. Griffiths, Amro Elshoury, Salma K. Jabbour, Christian F. Misdary, Mansi R. Shah, Babar Bashir, Christopher McNair, Sana Z. Mahmood, Vasil Mico, Andrea Verghese Rivera, Daniel B. Flora, Barbara B. Logan, Goetz Kloecker, Chaitanya Mandapakala, Sumit A. Shah, Elwyn C. Cabebe, Michael J. Glover, Alokkumar Jha, Lidia Schapira, Julie Tsu-Yu Wu, Suki Subbiah, Gilberto de Lima Lopes, Sanjay G. Revankar, Daniel G. Stover, Daniel Addison, James L. Chen, Margaret E. Gatti-Mays, Sachin R. Jhawar, Vidhya Karivedu, Maryam B. Lustberg, Joshua D. Palmer, Sarah Wall, Nicole Williams, Elizabeth Wulff-Burchfield, Anup Kasi, Natasha Edwin, Melissa Smits, David D. Chism, Susie Owenby, Deborah B. Doroshow, Matthew D. Galsky, Michael Wotman, Huili Zhu, Julie C. Fu, Alyson Fazio, Mark H. Sueyoshi, Kathryn E. Huber, Jonathan Riess, Kanishka G. Patel, Samuel M. Rubinstein, William A. Wood, Christopher Jensen, Vaibhav Kumar, Trisha M. Wise-Draper, Syed A. Ahmad, Punita Grover, Shuchi Gulati, Jordan Kharofa, Tahir Latif, Michelle Marcum, Cathleen Park, Hira G. Shaikh, Daniel W. Bowles, Christoper L. Geiger, Merry-Jennifer Markham, Rohit Bishnoi, Atlantis D. Russ, Chintan Shah, Jared D. Acoba, Young Soo Rho, Lawrence E. Feldman, Kent F. Hoskins, Gerald Gantt, Li C. Liu, Mahir Khan, Ryan H. Nguyen, Mary Pasquinelli, Candice Schwartz, Neeta K. Venepalli, Praveen Vikas, Christopher R. Friese, Leslie A. Fecher, Blanche H. Mavromatis, Ragneel R. Bijjula, Qamar U. Zaman, Jeremy L. Warner, Alex Cheng, Elizabeth J. Davis, Stephany N. Duda, Kyle T. Enriquez, Benjamin French, Erin A. Gillaspie, Cassandra Hennessy, Daniel Hausrath, Chih-Yuan Hsu, Douglas B. Johnson, Xuanyi Li, Sanjay Mishra, Sonya A. Reid, Brian I. Rini, David A. Slosky, Yu Shyr, Carmen C. Solorzano, Tianyi Sun, Matthew D. Tucker, Karen Vega-Luna, Lucy L. Wang, Hagen F. Kennecke, David M. Aboulafia, Brett A. Schroeder, Matthew Puc, Theresa M. Carducci, Karen J. Goldsmith, Susan Van Loon, Umit Topaloglu, Saif I. Alimohamed, Robert L. Rice, Wilhelmina D. Cabalona, Christine Pilar, Prakash Peddi, Lane R. Rosen, Briana Barrow McCollough, Mehmet A. Bilen, Deepak Ravindranathan, Navid Hafez, Roy Herbst, Patricia LoRusso, Tyler Masters, Catherine Stratton
Journal: JAMA Network Open (2022)

The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.