University of Alabama at Birmingham

How does COVID-19 affect patients with cancer? Largest U.S. study shares first results

Newswise — BIRMINGHAM, Ala. – In the largest study of its kind to date, researchers analyzing national data from more than 63,000 patients with cancer and a positive COVID-19 diagnosis report an increased risk of death among those who were older, male, had a higher number of comorbidities, and had hematologic cancers and recent chemotherapy treatments. 

These findings were shared in an oral presentation June 4 at the annual meeting of the American Society of Clinical Oncology by University of Alabama at Birmingham Assistant Professor Noha Sharafeldin, MBBCh, Ph.D. Sharafeldin is a medical doctor and epidemiologist in the Division of Hematology and Oncology and member of UAB’s Institute for Cancer Outcomes and Survivorship and the O’Neal Comprehensive Cancer Center

A more detailed journal article was published simultaneously in the society’s Journal of Clinical Oncology.  

The results are one of the first major publications from the National COVID Cohort Collaborative, known as N3C. UAB and 54 other clinical institutions nationwide have contributed de-identified electronic health record data from 6.2 million patients from 49 states to a secure, cloud-based database to enable first-of-its-kind research. The N3C began curating data in January 2020, and its database contains patient records dating back to 2018. Among the 6 billion rows of data collected are more than 2 million positive COVID diagnoses and more than 400,000 patients with a cancer diagnosis.

‘A scale that has not been possible before’

“People in the cancer world are very eager to get more information about the effects of

 

COVID-19 in general and the interaction with specific cancer types and cancer treatments,” Sharafeldin said. 

Previous studies in relatively small cohorts have found variation in risk for patients with cancer.  

“The N3C contains a huge amount of data that has allowed us to investigate these questions at a scale that has not been possible before, using real-world clinical data,” Sharafeldin said. “The strength of this first report is that it demonstrates the utility of resources like N3C and the collaborative research that has made it possible. There are other cancer/COVID patient cohorts out there, but nothing the size of N3C, or with the same level of representation of patients from across the country.”   

From its founding, N3C leadership has encouraged researchers interested in COVID-19’s effects on particular health conditions to form clinical domain teams. Along with Umit Topaloglu, Ph.D., an informatician from Wake Forest University, and Benjamin Bates, M.D., a clinician at Rutgers University, Sharafeldin is co-leading the N3C Oncology Domain Team

“We started by simply investigating the feasibility of answering these questions we had about COVID’s effects on patients with cancer using N3C’s data resources,” Sharafeldin said. “As we went along, the oncology domain team started expanding to include biostatisticians, bioinformatics and analysis experts, and researchers in machine learning and other advanced applications, as well as clinicians — all under the umbrella of being interested in cancer.”  

No. 1 question: Can it be done?

One of the strengths of N3C has been its harmonization of data from a wide range of different electronic medical records systems and hospital databases. Sharafeldin and the Oncology Domain Team first had to create their cancer cohort from the mass of data by defining terms and making sense of diagnostic codes and diagnosis timelines.  

“You could have a patient who was just diagnosed, or one who had been diagnosed many years before and was a survivor,” Sharafeldin said. “They could be in remission or receiving end-of-life care.”  

There have been a lot of challenges handling real-world data that researchers needed to navigate, including identifying the primary site of a patient’s cancer and defining categories of cancer treatment.  

“We have many questions, but we thought the No. 1 question to answer first was whether we could curate and describe a cancer cohort and examine mortality risk in our cohort,” Sharafeldin said. “Cancer patients are already a vulnerable population; we wanted to identify factors that put these patients at increased risk.”  

In her presentation and the accompanying manuscript, the Oncology Domain Team shared findings on those risk factors. 

Study findings

From a total of 398,579 adult patients with cancer identified in the N3C cohort, 63,413 (15.9 percent) were diagnosed as COVID-positive. The most common represented cancers were skin (13.8 percent), breast (13.7 percent), prostate (10.6 percent), hematologic (10.5 percent) and GI cancers (10 percent). COVID-19 positivity was significantly associated with increased risk of all-cause mortality. Among COVID-positive patients, several characteristics were associated with an increased risk of all-cause mortality:

  • age 65 or older
  • male gender
  • residents of the Southern or Western United States
  • adjusted Charlson Comorbidity Index score of 4 or greater
  • patients with hematologic malignancies
  • patients with multi-tumor sites
  • patients who had recent (within 30 days) chemotherapy treatment

“Age, male sex and increasing comorbidities have been found to be important risk factors for the population in general, and that stayed consistent in our cohort as well,” Sharafeldin said. 

Consistent with previous literature (including this June 2020 paper in The Lancet and this February 2021 paper in Annals of Oncology), patients with hematological malignancies had higher mortality, while the N3C dataset confirmed that “patients who received recent immunotherapies or targeted therapies did not have higher risk of overall mortality,” Sharafeldin and her co-authors wrote in their Journal of Clinical Oncology manuscript. 

Going forward, the researchers aim to dig deeper into the data to “provide further insights into the effects of COVID-19 including effects of vaccinations on cancer outcomes and the ability to continue specific cancer treatments,” they wrote.  

“We want to look deeper in patient records and take a more nuanced look at treatments,” Sharafeldin explained. “Future studies of the cohort will provide insights into the evolving effect of COVID-19 on patients with cancer and guide clinical management.” 

‘People interested in every aspect’

The long-distance collaborations and rapid time frame for the work have been tiring at times, Sharafeldin says, but also invigorating.  

 “It has been very collaborative and enjoyable and open,” she said, noting that the team includes everyone from full professors to graduate trainees. “Generally, you need to know someone, to have connections and mentors and a healthy network to get access to this type of data and be successful. With N3C, you just have to be willing to share your skills.”

Sharafeldin encourages other scientists, whatever their expertise, to visit the N3C website and engage with others around their area of interest. “There is a large diversity in the N3C domain teams covering a wide range of clinical interests,” Sharafeldin said. 

The recognition at ASCO and publication in a top-tier journal are some of the highest-profile results from N3C so far, which has everyone involved in the project excited, Sharafeldin says.  

“So many people have volunteered their time and worked on this,” Sharafeldin said. In addition to researchers and clinicians, there are specialists in programming and data analysis and database architecture from private companies and institutes.  

“Within every domain team, there are logic and data liaisons from N3C and experts in how the cohort is being created to help us navigate and provide consistent support, in addition to a knowledge store where researchers are sharing workflows and technical help,” she said. 

“The beauty of N3C is that it’s this really open environment, and if you are willing to lend your time and expertise, you can make a real difference,” Sharafeldin said. “Throughout this pandemic, everyone has wanted to contribute and help. Once you get an opportunity to do that, it’s very exciting.”

 

In addition to Sharafeldin, Topaloglu and Bates, co-authors of the Journal of Clinical Oncology manuscript are Qianqian Song, Ph.D., and Sharlene Dong of the Wake Forest School of Medicine; Vithal Madhira of Palila Software; Yao Yan, Timothy Bergquist, Ph.D., and Justin Guinney, Ph.D., of Sage Bionetworks; Eileen Lee and Nathaniel Kuhrt of Rutgers University; Yu Raymond Shao, M.D., Ph.D., of Duke University Medical Center; Feifan Liu, Ph.D., of the University of Massachusetts Medical School; and Jing Su, Ph.D., of the Indiana University School of Medicine. 

MEDIA CONTACT
Register for reporter access to contact details
CITATIONS

American Society of Clinical Oncology; Journal of Clinical Oncology



Filters close

Showing results

110 of 5872
Released: 24-Jun-2021 4:55 PM EDT
Virus that causes COVID-19 can find alternate route to infect cells
Washington University in St. Louis

The virus that causes COVID-19 normally gets inside cells by attaching to a protein called ACE2. Researchers at Washington University School of Medicine in St. Louis have found that a single mutation confers the ability to enter cells through another route, which may threaten the effectiveness of COVID-19 vaccines and therapeutics designed to block the standard route of entry.

Newswise: Is it a Virus or Bacteria? New Tech Rapidly Tests for COVID-19 and More
Released: 24-Jun-2021 3:05 PM EDT
Is it a Virus or Bacteria? New Tech Rapidly Tests for COVID-19 and More
Homeland Security's Science And Technology Directorate

S&T is preparing for future outbreaks/pandemics by investing in a new tech that can quickly discriminate between bacterial and viral infections so that the U.S. can triage patients and plan a response without delay.

Released: 24-Jun-2021 12:30 PM EDT
A tecnologia de IA e ECG pode descartar rapidamente a infecção por COVID-19, concluiu o estudo da Mayo Clinic
Mayo Clinic

A inteligência artificial (IA) pode oferecer uma maneira de determinar com precisão se uma pessoa não está infectada com a COVID-19. Um estudo retrospectivo internacional descobriu que a infecção pelo SARS-CoV-2, o vírus que causa a COVID-19, cria mudanças elétricas sutis no coração. Um eletrocardiograma (ECG) habilitado com IA pode detectar essas alterações e, potencialmente, ser usado como um teste de triagem rápido e confiável para descartar a infecção por COVID-19.

Released: 24-Jun-2021 12:10 PM EDT
妙佑医疗国际(Mayo Clinic)的研究发现,AI赋能的心电图技术有可能迅速排除COVID-19感染
Mayo Clinic

AI (人工智能)有可能提供准确判断一个人未感染COVID-19(2019冠状病毒病)的方法。一项国际回顾性研究发现,如果感染了导致COVID-19的SARS-CoV-2病毒,患者的心脏会产生微妙的电学变化。AI赋能的心电图(EKG)可以检测到这些变化,并有望被用于进行快速、可靠的COVID-19筛查检测,以排除COVID-19感染。

Newswise: 200421_Felgner_3205_sz-2-768x496.jpg
Released: 24-Jun-2021 11:50 AM EDT
UCI Professor Wins Spain’s Prestigious Princess of Asturias Award for Scientific Research
University of California, Irvine

Irvine, Calif., June 24, 2021 — Philip Felgner, Ph.D., professor in residence of physiology & biophysics at the University of California, Irvine, is one of seven scholars worldwide to win Spain’s prestigious Princess of Asturias Award for Technical and Scientific Research in recognition of their contributions to designing COVID-19 vaccines.

Released: 24-Jun-2021 11:00 AM EDT
New protein engineering method could accelerate the discovery of COVID-19 therapeutics
University of Michigan

Discovering and engineering nanobodies with properties suitable for treating human diseases ranging from cancer to COVID-19 is a time-consuming, laborious process.

Newswise: Decoding humans’ survival from coronaviruses
Released: 24-Jun-2021 11:00 AM EDT
Decoding humans’ survival from coronaviruses
University of Adelaide

An international team of researchers co-led by the University of Adelaide and the University of Arizona has analysed the genomes of more than 2,500 modern humans from 26 worldwide populations, to better understand how humans have adapted to historical coronavirus outbreaks.

access_time Embargo lifts in 2 days
Embargo will expire: 29-Jun-2021 4:00 PM EDT Released to reporters: 24-Jun-2021 10:35 AM EDT

A reporter's PressPass is required to access this story until the embargo expires on 29-Jun-2021 4:00 PM EDT The Newswise PressPass gives verified journalists access to embargoed stories. Please log in to complete a presspass application. If you have not yet registered, please Register. When you fill out the registration form, please identify yourself as a reporter in order to advance to the presspass application form.

Newswise: COVIDLockdownSimulations.jpg
Released: 24-Jun-2021 10:00 AM EDT
Pandemic Air Quality Affected By Weather, Not Just Lockdowns
Washington University in St. Louis

Using a diverse set of tools, the lab of Randall Martin shows how the pandemic did – or didn’t – affect levels of particulate matter during COVID lockdowns.

Released: 24-Jun-2021 6:05 AM EDT
Longest known SARS-CoV-2 infection of nearly 300 days successfully treated with new therapy
University of Bristol

An immunocompromised individual with the longest known PCR confirmed case of SARS-CoV-2 infection, lasting more than 290 days, has been successfully treated with two investigational monoclonal antibodies (laboratory engineered antibodies). Clinicians and researchers from the University of Bristol and North Bristol NHS Trust (NBT) worked closely to assess and treat the infection and want to highlight the urgent need for improved access to treatments for such people with persistent SARS-CoV-2 infection.


Showing results

110 of 5872

close
1.3441