Harshraj Leuva , Mengxi Zhou , Norbert Brau , Sheldon T. Brown , Prabhjot Mundi , Ta-Chueh Melody Rosenberg , Carol Luhrs , Susan E. Bates , Yeun-Hee Anna Park , Tito Fojo
{"title":"癌症对COVID-19发病率、结局和疫苗有效性的影响:美国退伍军人的前瞻性队列研究","authors":"Harshraj Leuva , Mengxi Zhou , Norbert Brau , Sheldon T. Brown , Prabhjot Mundi , Ta-Chueh Melody Rosenberg , Carol Luhrs , Susan E. Bates , Yeun-Hee Anna Park , Tito Fojo","doi":"10.1053/j.seminoncol.2022.07.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Coronavirus disease 2019 (COVID-19) has been a constant health threat since its emergence. Amongst risk factors proposed, a diagnosis of cancer has been worrisome. We report the impact of cancer and other risk factors in US Veterans receiving care at Veterans Administration (VA) Hospitals, their adjusted odds ratio (aOR) for infection and death, and report on the impact of vaccines on the incidence and severity of COVID-19 infections in Veterans without/with cancer.</p></div><div><h3>Methods</h3><p>We conducted a cohort study of US Veterans without/with cancer by mining VA COVID-19 Shared Data Resource (CSDR) data using the VA Informatics and Computing Infrastructure (VINCI). Our observation period includes index dates from 14DEC2020 to 25JAN2022, encompassing both the delta and omicron waves in the US.</p></div><div><h3>Results</h3><p>We identified 915,928 Veterans, 24% of whom were African Americans who had undergone COVID testing–688,541 were and 227,387 were not <em>vaccinated</em>. 157,072 had a cancer diagnosis in the preceding two years. Age emerged as the major risk factor, with gender, BMI, and (Elixhauser) comorbidity contributing less. Among veterans with solid tumors other than lung cancer, risks of infection and death within 60 days were comparable to Veterans without cancer. However, those with hematologic malignancies fared worse. Vaccination was highly effective across all cancer cohorts; the respective rates of infection and death after infection were 8% and 5% among the <em>vaccinated</em> compared to 47% and 10% in the <em>unvaccinated</em>. Amongst <em>vaccinated</em>, increased risk of infection was noted in both, Veterans with hematologic malignancy treated with chemotherapy (HR, 2.993, <em>P</em> < 0.0001) or targeted therapies (HR, 1.781, <em>P</em> < 0.0001), and in solid tumors treated with either chemotherapy (HR 2.328, 95%CI 2.075–2.611, <em>P</em> < 0.0001) or targeted therapies (HR 1.328, <em>P</em> < 0.0001) when compared to those not on treatment.</p></div><div><h3>Conclusions</h3><p>Risk for COVID-19 infection and death from infection vary based on cancer type and therapies administered. Importantly and encouragingly, the duration of protection from infection following vaccination in Veterans with a diagnosis of cancer was remarkably like those without a cancer diagnosis. Veterans with hematologic malignancies are especially vulnerable, with lower vaccine effectiveness (VE).</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":"49 5","pages":"Pages 363-370"},"PeriodicalIF":3.0000,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353607/pdf/","citationCount":"0","resultStr":"{\"title\":\"Influence of Cancer on COVID-19 Incidence, Outcomes, and Vaccine Effectiveness: A Prospective Cohort Study of U.S. Veterans\",\"authors\":\"Harshraj Leuva , Mengxi Zhou , Norbert Brau , Sheldon T. Brown , Prabhjot Mundi , Ta-Chueh Melody Rosenberg , Carol Luhrs , Susan E. Bates , Yeun-Hee Anna Park , Tito Fojo\",\"doi\":\"10.1053/j.seminoncol.2022.07.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>Coronavirus disease 2019 (COVID-19) has been a constant health threat since its emergence. Amongst risk factors proposed, a diagnosis of cancer has been worrisome. We report the impact of cancer and other risk factors in US Veterans receiving care at Veterans Administration (VA) Hospitals, their adjusted odds ratio (aOR) for infection and death, and report on the impact of vaccines on the incidence and severity of COVID-19 infections in Veterans without/with cancer.</p></div><div><h3>Methods</h3><p>We conducted a cohort study of US Veterans without/with cancer by mining VA COVID-19 Shared Data Resource (CSDR) data using the VA Informatics and Computing Infrastructure (VINCI). Our observation period includes index dates from 14DEC2020 to 25JAN2022, encompassing both the delta and omicron waves in the US.</p></div><div><h3>Results</h3><p>We identified 915,928 Veterans, 24% of whom were African Americans who had undergone COVID testing–688,541 were and 227,387 were not <em>vaccinated</em>. 157,072 had a cancer diagnosis in the preceding two years. Age emerged as the major risk factor, with gender, BMI, and (Elixhauser) comorbidity contributing less. Among veterans with solid tumors other than lung cancer, risks of infection and death within 60 days were comparable to Veterans without cancer. However, those with hematologic malignancies fared worse. Vaccination was highly effective across all cancer cohorts; the respective rates of infection and death after infection were 8% and 5% among the <em>vaccinated</em> compared to 47% and 10% in the <em>unvaccinated</em>. Amongst <em>vaccinated</em>, increased risk of infection was noted in both, Veterans with hematologic malignancy treated with chemotherapy (HR, 2.993, <em>P</em> < 0.0001) or targeted therapies (HR, 1.781, <em>P</em> < 0.0001), and in solid tumors treated with either chemotherapy (HR 2.328, 95%CI 2.075–2.611, <em>P</em> < 0.0001) or targeted therapies (HR 1.328, <em>P</em> < 0.0001) when compared to those not on treatment.</p></div><div><h3>Conclusions</h3><p>Risk for COVID-19 infection and death from infection vary based on cancer type and therapies administered. Importantly and encouragingly, the duration of protection from infection following vaccination in Veterans with a diagnosis of cancer was remarkably like those without a cancer diagnosis. Veterans with hematologic malignancies are especially vulnerable, with lower vaccine effectiveness (VE).</p></div>\",\"PeriodicalId\":21750,\"journal\":{\"name\":\"Seminars in oncology\",\"volume\":\"49 5\",\"pages\":\"Pages 363-370\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2022-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353607/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Seminars in oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0093775422000598\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0093775422000598","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
2019冠状病毒病(COVID-19)自出现以来一直是健康威胁。在提出的风险因素中，癌症的诊断一直令人担忧。我们报告了在退伍军人管理局(VA)医院接受治疗的美国退伍军人中癌症和其他危险因素的影响，其感染和死亡的调整优势比(aOR)，并报告了疫苗对无癌症/患有癌症的退伍军人中COVID-19感染的发生率和严重程度的影响。方法利用VA Informatics and Computing Infrastructure (VINCI)对VA COVID-19共享数据资源(CSDR)数据进行挖掘，对未患/患有癌症的美国退伍军人进行队列研究。我们的观察期包括指数日期从2020年12月14日到2022年1月25日，包括美国的delta波和ommicron波。结果我们确定了915,928名退伍军人，其中24%是接受过COVID检测的非洲裔美国人- 688,541人未接种疫苗，227,387人未接种疫苗。157,072人在前两年被诊断出患有癌症。年龄成为主要的危险因素，性别、BMI和(Elixhauser)合并症的影响较小。在患有肺癌以外的实体瘤的退伍军人中，感染和60天内死亡的风险与未患癌症的退伍军人相当。然而，那些血液恶性肿瘤患者的情况更糟。疫苗接种在所有癌症队列中都非常有效;接种疫苗者的感染率和感染后死亡率分别为8%和5%，而未接种疫苗者分别为47%和10%。在接种疫苗的退伍军人中，接受化疗的血液病恶性肿瘤感染风险增加(HR, 2.993, P <0.0001)或靶向治疗(HR, 1.781, P <0.0001)，在接受化疗的实体肿瘤中(HR 2.328, 95%CI 2.075-2.611, P <0.0001)或靶向治疗(HR 1.328, P <0.0001)，与未接受治疗的患者相比。结论COVID-19感染和感染死亡的风险因癌症类型和治疗方法而异。重要且令人鼓舞的是，诊断为癌症的退伍军人接种疫苗后免受感染的持续时间与未诊断为癌症的退伍军人非常相似。患有血液恶性肿瘤的退伍军人尤其脆弱，疫苗有效性(VE)较低。
Influence of Cancer on COVID-19 Incidence, Outcomes, and Vaccine Effectiveness: A Prospective Cohort Study of U.S. Veterans
Purpose
Coronavirus disease 2019 (COVID-19) has been a constant health threat since its emergence. Amongst risk factors proposed, a diagnosis of cancer has been worrisome. We report the impact of cancer and other risk factors in US Veterans receiving care at Veterans Administration (VA) Hospitals, their adjusted odds ratio (aOR) for infection and death, and report on the impact of vaccines on the incidence and severity of COVID-19 infections in Veterans without/with cancer.
Methods
We conducted a cohort study of US Veterans without/with cancer by mining VA COVID-19 Shared Data Resource (CSDR) data using the VA Informatics and Computing Infrastructure (VINCI). Our observation period includes index dates from 14DEC2020 to 25JAN2022, encompassing both the delta and omicron waves in the US.
Results
We identified 915,928 Veterans, 24% of whom were African Americans who had undergone COVID testing–688,541 were and 227,387 were not vaccinated. 157,072 had a cancer diagnosis in the preceding two years. Age emerged as the major risk factor, with gender, BMI, and (Elixhauser) comorbidity contributing less. Among veterans with solid tumors other than lung cancer, risks of infection and death within 60 days were comparable to Veterans without cancer. However, those with hematologic malignancies fared worse. Vaccination was highly effective across all cancer cohorts; the respective rates of infection and death after infection were 8% and 5% among the vaccinated compared to 47% and 10% in the unvaccinated. Amongst vaccinated, increased risk of infection was noted in both, Veterans with hematologic malignancy treated with chemotherapy (HR, 2.993, P < 0.0001) or targeted therapies (HR, 1.781, P < 0.0001), and in solid tumors treated with either chemotherapy (HR 2.328, 95%CI 2.075–2.611, P < 0.0001) or targeted therapies (HR 1.328, P < 0.0001) when compared to those not on treatment.
Conclusions
Risk for COVID-19 infection and death from infection vary based on cancer type and therapies administered. Importantly and encouragingly, the duration of protection from infection following vaccination in Veterans with a diagnosis of cancer was remarkably like those without a cancer diagnosis. Veterans with hematologic malignancies are especially vulnerable, with lower vaccine effectiveness (VE).
期刊介绍：
Seminars in Oncology brings you current, authoritative, and practical reviews of developments in the etiology, diagnosis and management of cancer. Each issue examines topics of clinical importance, with an emphasis on providing both the basic knowledge needed to better understand a topic as well as evidence-based opinions from leaders in the field. Seminars in Oncology also seeks to be a venue for sharing a diversity of opinions including those that might be considered "outside the box". We welcome a healthy and respectful exchange of opinions and urge you to approach us with your insights as well as suggestions of topics that you deem worthy of coverage. By helping the reader understand the basic biology and the therapy of cancer as they learn the nuances from experts, all in a journal that encourages the exchange of ideas we aim to help move the treatment of cancer forward.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
