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 LV 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; Runolfur Palsson; Elias Eythorsson; Sandra Iranaeus; Mats Lambe; Giske Ursin

doi:10.1016/j.lanepe.2023.100680

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 LV 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, Runolfur Palsson, Elias Eythorsson, Sandra Iranaeus, Mats Lambe, Giske Ursin

Landssjúkrahúsið - The National Hospital of the Faroe Islands

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Summary
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 language	English
Article number	100680
Number of pages	11
Journal	The Lancet Regional Health - Europe
Volume	31
DOIs	https://doi.org/10.1016/j.lanepe.2023.100680
Publication status	Published - 10 Jul 2023

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.lanepe.2023.100680Licence: CC BY

Cite this

Johansson, A. LV., Skog, A., Johannesen, T. B., Myklebust, T. Å., Skovlund, C. W., Mørch, L. S., Friis, S., Gamborg, M., Kristiansen, M. F., Pettersson, D., Ólafsdóttir, E. J., Birgisson, H., Palsson, R., Eythorsson, E., Iranaeus, S., Lambe, M., & Ursin, G. (2023). 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. The Lancet Regional Health - Europe, 31, Article 100680. https://doi.org/10.1016/j.lanepe.2023.100680

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title = "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",

abstract = "SummaryBackgroundIn 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.MethodsIn 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.FindingsDuring 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.InterpretationCancer 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.FundingNordic Cancer Union.",

keywords = "covid-19, Coronavirus disease 2019, SARS-CoV-2, evere acute respiratory syndrome coronavirus 2, Cancer, Hospitalisation, Critical care outcomes, Intensive care, Mortality, Nordic, Denmark, Norway, Iceland",

author = "Johansson, {Anna LV} and Anna Skog and Johannesen, {Tom B{\o}rge} and Myklebust, {Tor {\AA}ge} and Skovlund, {Charlotte Wessel} and M{\o}rch, {Lina Steinrud} and S{\o}ren Friis and Mads Gamborg and Kristiansen, {Marnar Fr{\'i}{\dh}heim} and David Pettersson and {\'O}lafsd{\'o}ttir, {El{\'i}nborg J} and Helgi Birgisson and Runolfur Palsson and Elias Eythorsson and Sandra Iranaeus and Mats Lambe and Giske Ursin",

year = "2023",

month = jul,

day = "10",

doi = "10.1016/j.lanepe.2023.100680",

language = "English",

volume = "31",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier B.V.",

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Johansson, ALV, Skog, A, Johannesen, TB, Myklebust, TÅ, Skovlund, CW, Mørch, LS, Friis, S, Gamborg, M, Kristiansen, MF, Pettersson, D, Ólafsdóttir, EJ, Birgisson, H, Palsson, R, Eythorsson, E, Iranaeus, S, Lambe, M & Ursin, G 2023, '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', The Lancet Regional Health - Europe, vol. 31, 100680. https://doi.org/10.1016/j.lanepe.2023.100680

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. / Johansson, Anna LV; Skog, Anna; Johannesen, Tom Børge et al.
In: The Lancet Regional Health - Europe, Vol. 31, 100680, 10.07.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Were cancer patients worse off than the general population during the COVID-19 pandemic?

T2 - A population-based study from Norway, Denmark and Iceland during the pre-vaccination era

AU - Johansson, Anna LV

AU - Skog, Anna

AU - Johannesen, Tom Børge

AU - Myklebust, Tor Åge

AU - Skovlund, Charlotte Wessel

AU - Mørch, Lina Steinrud

AU - Friis, Søren

AU - Gamborg, Mads

AU - Kristiansen, Marnar Fríðheim

AU - Pettersson, David

AU - Ólafsdóttir, Elínborg J

AU - Birgisson, Helgi

AU - Palsson, Runolfur

AU - Eythorsson, Elias

AU - Iranaeus, Sandra

AU - Lambe, Mats

AU - Ursin, Giske

PY - 2023/7/10

Y1 - 2023/7/10

N2 - SummaryBackgroundIn 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.MethodsIn 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.FindingsDuring 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.InterpretationCancer 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.FundingNordic Cancer Union.

AB - SummaryBackgroundIn 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.MethodsIn 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.FindingsDuring 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.InterpretationCancer 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.FundingNordic Cancer Union.

KW - covid-19

KW - Coronavirus disease 2019

KW - SARS-CoV-2

KW - evere acute respiratory syndrome coronavirus 2

KW - Cancer

KW - Hospitalisation

KW - Critical care outcomes

KW - Intensive care

KW - Mortality

KW - Nordic

KW - Denmark

KW - Norway

KW - Iceland

U2 - 10.1016/j.lanepe.2023.100680

DO - 10.1016/j.lanepe.2023.100680

M3 - Article

SN - 2666-7762

VL - 31

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100680

ER -