Risk, Racial Disparity, and Outcomes Among Patients With Cancer and COVID-19 Infection | Oncology | JAMA Oncology | JAMA Network
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Comment & Response
May 6, 2021

Risk, Racial Disparity, and Outcomes Among Patients With Cancer and COVID-19 Infection

Author Affiliations
  • 1Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
JAMA Oncol. 2021;7(7):1064-1065. doi:10.1001/jamaoncol.2021.0765

To the Editor We read with interest the Original Investigation in JAMA Oncology by Wang et al.1 Although these findings could be timely and impactful, insufficient data were presented to understand their validity, including the strong conclusions regarding associations between cancer, hospitalization, death, and COVID-19 infection. There were no details defining the outcome variables (hospitalization, death). Recognizing word limitations, the granularity below is suggested to understand these findings.

Many predictors analyzed are potentially time dependent; each would differ in meaning if occurring at a time remote from vs during or immediately following COVID-19 infection. The relevance of a “recent” cancer (defined as “within or before the last year”1) may be minimal if diagnosed long before infection with no recent therapy. Hospitalizations/deaths may have occurred several months after vs during or immediately following COVID-19 infection and be unrelated to infection, making this association tenuous; hospitalizations may predate infection. Similar timeline questions surround transplant procedures and nursing home stays.

There is no clear consideration of model building, which is critical in the absence of data regarding the time frame of these predictors. Nursing home stays may be in the pathway from comorbidities to COVID-19 infection; COVID-19 infection may be in the pathway from comorbidities to nursing home stays. The authors illustrate associations between comorbidities, treatments, transplants, nursing home stays, and COVID-19 infection using the differences between adjusted and unadjusted odds ratios, without providing odds ratios/significance for the predictors. Thus, their importance is unclear. With clear predictor timelines and strategic model building, clinicians could start conceptualizing COVID-19 risks associated with cancer, treatments, and comorbidities.

Drawing conclusions surrounding race/ethnicity is tenuous with descriptions of data that lack clarity and underrepresentation of Hispanic/Latino patients. How patients were handled analytically if multiple (or missing) races/ethnicities were identified is unclear. Demographic analyses included only non-Latino White or African American patients, but other analytic models possibly included unknowns; the unknown category ranges from 5% to 12% but does not include all unknown race/ethnicity (the sum of the columns falls short of the total).

While medicine adapts to the evolving COVID-19 pandemic, it is critical to rapidly disseminate data. Nevertheless, placing these findings in context remains vital. We are cancer health services researchers who champion the use of administrative and electronic health record data, fully supporting their use to undertake such case-control studies. The authors conclude that together, cancer and COVID-19 synergistically influence hospitalization and death rates.1 While their potentially robust findings may be able to contribute invaluably to pandemic knowledge, the strength of their conclusions should be considered hypothesis generating rather than definitive, in our humble opinions.

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Article Information

Corresponding Author: Julie A. Wolfson, MD, MSHS, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Ave S, Lowder 500, Birmingham, AL 35233 (jwolfson@peds.uab.edu).

Published Online: May 6, 2021. doi:10.1001/jamaoncol.2021.0765

Conflict of Interest Disclosures: None reported.

References
1.
Wang  Q, Berger  NA, Xu  R.  Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection.   JAMA Oncol. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178PubMedGoogle ScholarCrossref
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