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In Reply We thank Dekker, Peng et al, Maitland et al, and Robinson et al for their interest and insightful comments on our article.1 These authors raised salient points on confounders, such as older age and cigarette smoking, on the higher incidence of coronavirus disease 2019 (COVID-19) in our cohort of patients with cancer. Additionally, Maitland et al and Robinson et al queried our secondary observation that older patients with lung cancer represented a particularly susceptible subgroup. We will attempt to respond to these points.
In our article, we had acknowledged that age is a confounder of our findings because most solid cancers tend to occur in older patients. Compounding this conundrum, a study of 32 583 COVID-19 cases in Wuhan, China, from December 8, 2019, to March 8, 2020, revealed a positive association between the daily rate of cases and age (relative risk of 2.33 for patients aged 60-79 years compared with those aged 20-39 years).2 To resolve this, one would need to perform an age-standardized comparison of incidence of COVID-19 cases between patients with cancer and patients without cancer.
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Chua MLK, Yu J, Xie C. Risk of COVID-19 in Patients With Cancer—Reply. JAMA Oncol. Published online July 02, 2020. doi:10.1001/jamaoncol.2020.2589
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