The aim of this population-based work was to evaluate the impact of having had cancer on COVID 19 risk and prognosis during the first wave of the pandemic (27 February to 13 May 2020) in Reggio Emilia Province. Prevalent cancer cases diagnosed between 1996 and 2020 were linked with the provincial COVID 19 surveillance system. We compared cancer survivors cumulative incidence of being tested, testing positive for SARSCoV2, and dying of COVID 19 with that of the general population; among COVID19 patients, we compared cancer survivors risk of dying with that of other patients. During the study period 15,391 people (1,525 cancer survivors CS) underwent RTPCR for SARSCoV2, of whom 4,541 (449 CS) tested positive; 549 (114 CS) died of COVID-19. The probability of undergoing testing was 29.5% in the general population as well in CS, while the cumulative incidence of being tested, testing positive, and COVID19 death were lower in CS: age- and sex-adjusted Incidence Rate Ratios were 0.69 [95%CI 0.65-0.73], 0.55 [95%CI 0.50-0.61], and 0.52 [95%CI 0.42-0.64], respectively. Cancer survivors had worse prognosis when diagnosed with COVID19, particularly those below the age of 70 (odds ratio (OR) of death 4.91 [95%CI 2.38-10.09]), while the OR decreased after age 80 (1.20 [95%CI 0.87-1.65]). The OR was higher for patients with a recent diagnosis (<2 years OR=2.99 [95%CI 1.52-5.89]) or metastases (OR=2.14 [95%CI 0.89-5.16]). Cancer patients may have adopted behaviors that protected them from infection, but they were still at higher risk of death once infected.
COVID-19 patients and cancer in northern Italy