Patients with cancer have an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection and worse outcomes, with the highest risk seen for patients with hematologic cancer, according to a study published online Dec. 29 in JAMA Oncology.
Inna Y. Gong, M.D., Ph.D., from the University of Toronto and Sunnybrook Health Sciences Centre, and colleagues examined the association of COVID-19 vaccination with breakthrough infections and complications in patients with cancer versus non-cancer controls. Data were included for 289,400 vaccinated patients with cancer (39,880 with hematologic cancer and 249,520 with solid cancer) and 1,157,600 matched noncancer controls.
The researchers found that patients with hematologic cancer had an increased risk for SARS-CoV-2 breakthrough infection (adjusted hazard ratio [aHR], 1.33; 95 percent confidence interval [CI], 1.20 to 1.46; P < 0.001), but patients with solid cancer did not (aHR, 1.00; 95 percent CI, 0.96 to 1.05; P = 0.87). Severe outcomes of COVID-19 (composite of hospitalization and death) were significantly higher in patients with versus without cancer (aHR, 1.52; 95 percent CI, 1.42 to 1.63; P < 0.001). The risk for severe outcomes was higher for patients with hematologic versus solid cancer (aHRs [95 percent CIs], 2.51 [2.21 to 2.85; P < 0.001] and 1.43 [1.24 to 1.64; P < 0.001], respectively). The risk for COVID-19 severe outcomes was further heightened for patients receiving active treatment, especially for those who received anti-CD20 therapy. Lower infection and COVID-19 complications were seen in association with the third vaccine dose, except for patients receiving anti-CD20 therapy.
“Our findings support the prioritization of high-risk populations for booster vaccination, forthcoming variant-specific vaccine products, pre-exposure prophylaxis (where available), and rapid antiviral treatment in the face of SARS-CoV-2 infection as COVID-19 continues to be relevant with ongoing surges leading to excess morbidity and mortality,” the authors write.
Inna Y. Gong et al, Association of COVID-19 Vaccination With Breakthrough Infections and Complications in Patients With Cancer, JAMA Oncology (2022). DOI: 10.1001/jamaoncol.2022.6815
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