Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States.

Autor:	Hawley JE; Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York.; now with Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle., Sun T; Vanderbilt University Medical Center, Nashville, Tennessee., Chism DD; Thompson Cancer Survival Center, Knoxville, Tennessee., Duma N; University of Wisconsin Carbone Cancer Center, Madison., Fu JC; Tufts Medical Center Cancer Center, Boston and Stoneham, Massachusetts., Gatson NTN; Geisinger Health System, Danville, Pennsylvania.; Banner MD Anderson Cancer Center, Gilbert, Arizona., Mishra S; Vanderbilt University Medical Center, Nashville, Tennessee., Nguyen RH; University of Illinois Hospital & Health Sciences System, Chicago., Reid SA; Vanderbilt University Medical Center, Nashville, Tennessee., Serrano OK; Hartford HealthCare Cancer Institute, Hartford, Connecticut., Singh SRK; Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan., Venepalli NK; University of North Carolina, Lineberger Cancer Center, Chapel Hill., Bakouny Z; Dana-Farber Cancer Institute, Boston, Massachusetts., Bashir B; Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania., Bilen MA; Winship Cancer Institute of Emory University, Atlanta, Georgia., Caimi PF; Case Comprehensive Cancer Center at Case Western Reserve University/University Hospitals, Cleveland, Ohio., Choueiri TK; Dana-Farber Cancer Institute, Boston, Massachusetts., Dawsey SJ; Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio., Fecher LA; University of Michigan Rogel Cancer Center, Ann Arbor., Flora DB; St Elizabeth Healthcare, Edgewood, Kentucky., Friese CR; University of Michigan Rogel Cancer Center, Ann Arbor., Glover MJ; Stanford Cancer Institute at Stanford University, Palo Alto, California., Gonzalez CJ; University of Michigan Rogel Cancer Center, Ann Arbor., Goyal S; George Washington University, Washington, DC., Halfdanarson TR; Mayo Clinic, Rochester, Minnesota., Hershman DL; Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York., Khan H; Brown University and Lifespan Cancer Institute, Providence, Rhode Island., Labaki C; Dana-Farber Cancer Institute, Boston, Massachusetts., Lewis MA; Intermountain Healthcare, Salt Lake City, Utah., McKay RR; University of California, San Diego., Messing I; George Washington University, Washington, DC., Pennell NA; Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio., Puc M; Virtua Health, Marlton, New Jersey., Ravindranathan D; Winship Cancer Institute of Emory University, Atlanta, Georgia., Rhodes TD; Intermountain Healthcare, Salt Lake City, Utah., Rivera AV; Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania., Roller J; University of Kansas Medical Center, Kansas City., Schwartz GK; Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York., Shah SA; Stanford Cancer Institute at Stanford University, Palo Alto, California., Shaya JA; University of California, San Diego., Streckfuss M; Advocate Aurora Health, Milwaukee, Wisconsin., Thompson MA; Advocate Aurora Health, Milwaukee, Wisconsin., Wulff-Burchfield EM; University of Kansas Medical Center, Kansas City., Xie Z; Mayo Clinic, Rochester, Minnesota., Yu PP; Hartford HealthCare Cancer Institute, Hartford, Connecticut., Warner JL; Vanderbilt University Medical Center, Nashville, Tennessee., Shah DP; Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, Texas., French B; Vanderbilt University Medical Center, Nashville, Tennessee., Hwang C; Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Jan 04; Vol. 5 (1), pp. e2142046. Date of Electronic Publication: 2022 Jan 04.
DOI:	10.1001/jamanetworkopen.2021.42046
Abstrakt:	Importance: 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. Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants: 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. Exposures: 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. Main Outcomes and Measures: 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. Results: 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). Conclusions and Relevance: 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.
Databáze:	MEDLINE
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