Were cancer patients worse off than the general population during the COVID-19 pandemic? A population-based study from Norway, Denmark and Iceland during the pre-vaccination era

Anna L.V. Johansson*, Anna Skog, Tom Børge Johannesen, Tor Åge Myklebust, Charlotte Wessel Skovlund, Lina Steinrud Mørch, Søren Friis, Mads Gamborg, Marnar Fríðheim Kristiansen, David Pettersson, Elínborg J. Ólafsdóttir, Helgi Birgisson, Runólfur Pálsson, Elias Eythorsson, Sandra Irenaeus, Mats Lambe, Giske Ursin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In a population-based setting, we investigated the risks of testing positive for SARS-CoV-2 and developing severe COVID-19 outcomes among cancer patients compared with the general population. Methods: In nationwide cohorts, we identified all individuals in Norway, Denmark and Iceland who tested positive for SARS-CoV-2 or had a severe COVID-19 outcome (hospitalisation, intensive care, and death) from March until December 2020, using data from national health registries. We estimated standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) comparing cancer patients with the general population. Findings: During the first wave of the pandemic, cancer patients in Norway and Denmark had higher risks of testing SARS-CoV-2 positive compared to the general population. Throughout 2020, recently treated cancer patients were more likely to test SARS-CoV-2 positive. In Iceland, cancer patients experienced no increased risk of testing positive. The risk of COVID-19-related hospitalisation was higher among cancer patients diagnosed within one year of hospitalisation (Norway: SIR = 2.43, 95% CI 1.89–3.09; Denmark: 2.23, 1.96–2.54) and within five years (Norway: 1.58, 1.35–1.83; Denmark: 1.54, 1.42–1.66). Risks were higher in recently treated cancer patients and in those diagnosed with haematologic malignancies, colorectal or lung cancer. Risks of COVID-19-related intensive care and death were higher among cancer patients. Interpretation: Cancer patients were at increased risk of testing positive for SARS-CoV-2 during the first pandemic wave when testing availability was limited, while relative risks of severe COVID-19 outcomes remained increased in cancer patients throughout 2020. Recent cancer treatment and haematologic malignancy were the strongest risk factors. Funding: Nordic Cancer Union.

Original languageEnglish
Article number100680
Pages (from-to)100680
JournalThe Lancet Regional Health - Europe
Volume31
DOIs
Publication statusPublished - 1 Aug 2023

Bibliographical note

Funding Information:
Nordic Cancer Union.We would like to thank Statens Serum Institut (SSI), Denmark, for providing data from the Danish Microbiology Database (MiBA) for this article. This study was funded by the Nordic Cancer Union (NCU: R276-A15785; PI: Ursin). The funder had no role in the data collection or interpretation of the findings.

Funding Information:
We would like to thank Statens Serum Institut (SSI), Denmark, for providing data from the Danish Microbiology Database (MiBA) for this article. This study was funded by the Nordic Cancer Union (NCU: R276-A15785 ; PI: Ursin). The funder had no role in the data collection or interpretation of the findings.

Publisher Copyright:
© 2023 The Author(s)

Other keywords

  • Cancer
  • Coronavirus disease 2019
  • COVID-19
  • Critical care outcomes
  • Denmark
  • Hospitalisation
  • Iceland
  • Intensive care
  • Mortality
  • Nordic
  • Norway
  • SARS-CoV-2
  • Severe acute respiratory syndrome coronavirus 2

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