Key Points Question To what extent are spatiotemporal trends in the COVID-19 pandemic in the United States associated with outcomes for patients with cancer infected with SARS-CoV-2? Findings This cohort study of 4749 patients with cancer and COVID-19 found no significant differences in outcomes across the 9 US census divisions. Overall, outcomes significantly improved between March and December 2020, and treatment at cancer centers in less densely populated counties was associated with better outcomes. Meaning These findings suggest that understanding the heterogeneity in COVID-19 outcomes between cancer centers could guide resource allocation and help the oncology community improve COVID-19 outcomes for this patient population. This cohort study examines spatiotemporal variation in COVID-19 outcomes among patients with cancer in the United States. Importance The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Exposures Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. Main Outcomes and Measures The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division–level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Results Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). Conclusions and Relevance In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.
【초록키워드】 COVID-19, Treatment, intensive care, mechanical ventilation, COVID-19 pandemic, Cancer, Variation, Diagnosis, outcome, risk factor, heterogeneity, cohort study, outcomes, Characteristics, female, Patient, COVID-19 diagnosis, death, Community, age, mortality rate, resource, Admission, Care, association, Hispanic, 30-Day mortality, neoplasm, exposure, Patients with cancer, retrospective cohort study, black, Attention, Cancer center, adjusted odds ratio, oncology, Primary outcome, significant difference, higher risk, 95% CI, no significant difference, Secondary outcomes, all-cause mortality, statistically significant difference, help, measure, laboratory-confirmed SARS-CoV-2 infection, participant, South, West, finding, patient population, mixed-effects model, division, continuum, vulnerable patients, divisions, The United States, objective, spatiotemporal, setting, invasive, 30-day mortality rate, IMPROVE, Result, collected, significantly, reported, the United State, median, adjusted, less, individuals, Importance, ranged, severe complication, quantified, Point, Relevance, 【제목키워드】 COVID-19, assessment, Regional, the United State,