6/18/2021 ~ The ASCO Post ~ By Matthew Stenger

All-Cause Mortality in COVID-19–Positive and COVID-19–Negative Patients With Cancer

In a large cohort study reported by Sharafeldin et al in the Journal of Clinical Oncology, researchers from the National COVID Cohort Collaborative (N3C) found that COVID-19–positive vs –negative status was associated with an increased risk of all-cause mortality at 1 year among patients with cancer.

As stated by the investigators, “Variation in risk of adverse clinical outcomes in patients with cancer and COVID-19 has been reported from relatively small cohorts. The National Center for Advancing Translational Sciences N3C is a centralized data resource representing the largest multicenter cohort of COVID-19 cases and controls nationwide.”

Study Details

The study included 398,579 adult outpatients and inpatients with cancer from 50 U.S. centers identified from the N3C cohort with a COVID-19–positive or COVID-19–negative diagnosis between January 1, 2020, and March 25, 2021. Patients were followed from time of an index clinical encounter. At each site, all patients with COVID-19 with any encounter after January 1, 2020, were included in the cohort. All patients without COVID-19 were initially included from contributing sites, and from December 2020, were randomly selected from the corresponding site in a 2:1 ratio to match the overall prevalence of age, sex, and race/ethnicity of patient with COVID-19. The COVID-19–positive analytic cohort was limited to patients with COVID-19 who had their earliest COVID-19 diagnosis within 21 days before and up to 5 days after the start of the index encounter.

Among all patients, the most common cancer types were skin (13.8%), breast (13.7%), prostate (10.6%), hematologic (10.5%), and gastrointestinal (10%).

Among all 398,579 patients, 63,413 (15.9%) were COVID-19–positive and 335,166 were negative. A total of 38,614 COVID-19–positive patients were included in the analytic cohort.

Among the 373,780 patients in the analytic cohort, the index encounter was a hospitalization visit for 204,503 (55%), including 19,515 COVID-19–positive and 184,988 COVID-19–negative patients.


  • Among COVID-19–positive patients, factors significantly associated with increased risk of 1-year all-cause mortality were age > 65 years, male sex, living in Southern and Western U.S. regions, increased number of comorbidities, hematologic malignancies and multisite tumors, and recent cytotoxic therapy.
  • Factors significantly associated with decreased risk were non-Hispanic Black race, recent hormonal therapy, and treatment of COVID-19 with dexamethasone.

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