Inside Excess Deaths From Cancer and COVID Early in the Pandemic

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In the first 10 months of the pandemic before vaccines were available, 16,561 US deaths occurred among people with both cancer and COVID-19, according to a research letter published in JAMA Oncology.

The deadliest cancer types to pair with COVID-19 were blood cancers and prostate cancer; in addition, researchers found these patients were more likely to die in a hospital or long-term care facility if they had COVID-19 and cancer than if they only had cancer.

Having a more granular understanding of the deaths associated with COVID-19 and cancer can help oncologists identify patients most at risk for poor outcomes and a host of other factors.

For instance, lead author Xuesong Han, PhD, noted that “the place of death not only affects patients’ end-of-life quality and family and caregivers’ grief during bereavement…but additionally, more inpatient deaths can affect end-of-life medical expenditures by the family and the healthcare system.”

Although previous research has demonstrated the effect the pandemic has had on cancer care and outcomes, limited evidence exists on excess deaths associated with COVID-19 and cancer during the first year of the pandemic, prior to vaccine availability.

The researchers used the CDC WONDER database to examine causes of death based on US residents’ death certificates from March 1 through December 31, 2020, and identified four groups:

• Those who died from cancer as an underlying cause and COVID-19 as a contributing cause.

• Those who died from COVID-19 as an underlying cause and cancer as a contributing cause.

• Those who died from cancer without COVID-19 as a contributing cause.

• Those who died from COVID-19 without cancer as a contributing cause.

Among the 16,561 people who died with COVID-19 and cancer, 3142 were cancer deaths with COVID-19 as a contributing factor, and 13,419 were COVID-19 deaths among people whose cancer contributed to death. Nearly half a million people (497,965) died of cancer without having COVID-19, and 337,393 people died of COVID-19 without cancer.

A quarter of cancer-related COVID deaths (25.5%) and 13.7% of COVID-related cancer deaths involved hematologic cancers, compared with just 9.5% of cancer deaths that didn’t involve COVID-19. As for solid tumors, prostate cancer was more prevalent among deaths from cancer and COVID-19 than in non–COVID-related cancer deaths, whereas gastrointestinal cancer and female genital cancers weren’t as prevalent among cancer-COVID-19 deaths.

“Patients with blood cancers are immunocompromised, and patients with prostate cancer tend to be older, both of which can increase the risks of COVID-19 complications and death,” said Han, scientific director of Health Services Research at the American Cancer Society.

Deaths involving both cancer and COVID-19 were more likely to occur in larger metropolitan areas as well as in inpatient care facilities, nursing homes, or long-term care homes. In addition,…