Older age, male gender, and increasing comorbidities increase the risk for death among patients with cancer who contract COVID-19, according to a study of a large nationally representative cohort of patients with both diseases.

Using the National COVID Cohort Collaborative (N3C) database, investigators identified 398,579 adult patients with cancer in the United States, including 63,413 (15.9%) patients who tested positive for COVID-19. A total of 38,614 COVID-19-positive cases with cancer met criteria for study inclusion. The most common cancers represented in this cohort were skin (14.9%), breast (14.2%), prostate (12.3%), hematologic (12.3%), and gastrointestinal cancers (8.8%). Multisite tumors were present in 10.9%.

“Using N3C, we assembled the largest nationally representative cohort of patients with cancer and COVID-19 to date,” Noha Sharafeldin, MD, PhD, MSc, of The University of Alabama at Birmingham School of Medicine, and colleagues wrote in the Journal of Clinical Oncology. “We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer.”

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Study results showed that COVID-19 positivity was significantly associated with a 1.2-fold increased risk for all-cause mortality, according to the investigators. Among the patients with COVID-19, those aged 65 years or older had a significant 2.0-fold increased risk for death compared with patients aged 18-29 years in adjusted analyses. Women had a significant 10% decreased risk for death compared with men. Results showed that the risk for death increased with Charlson Comorbidity Index (CCI). Compared with a CCI of 0, a CCI of 2, 3, or 4 or more significantly increased the risk for death by 1.3-, 1.6, and 2.0-fold, respectively.

The study also revealed geographical differences in death risk among patients with COVID-19. Compared with patients in the Northeast, those in the South and West had a significant 1.3- and 1.7-fold increased risk for death, respectively.

Patients with hematologic malignancies and multitumor sites and those who received recent cytotoxic therapy also had significantly increased risks for death.

“Consistent with previous literature, older age, male gender, and increasing comorbidities were associated with higher mortality in patients with cancer and COVID-19,” Dr Sharafeldin’s team concluded. “The N3C data set also confirmed that patients with cancer and COVID-19 who received recent immunotherapies or targeted therapies were not at higher risk for overall mortality.”

The N3C is a centralized data resource representing the largest multicenter cohort of COVID-19 cases and controls nationwide, the investigators noted.


Sharafeldin N, Bates B, Song Q, et al. Outcomes of COVID-19 in patients with cancer: Report from the National COVID Cohort Collaborative (N3C). J Clin Oncol. 2021;39:2232-2246. doi:10.1200/JCO.21.01074