# SARS-CoV-2 Infection Risk and COVID-19 Prevalence and Mortality in Cancer Patients During the First Wave of COVID-19 Pandemic in a Virus Epicenter in Northern Italy

## TL;DR

Cancer patients, especially those undergoing treatment, faced higher risks of SARS-CoV-2 infection and death during the first wave of the pandemic in Italy.

## Contribution

This study provides empirical evidence on the increased vulnerability of cancer patients to SARS-CoV-2 and highlights cancer subtype-specific risks.

## Key findings

- Cancer patients had a 1.67 times higher risk of SARS-CoV-2 infection compared to the general population.
- Patients on active cancer treatment had an 1.83 times higher risk of all-cause death.
- Breast cancer patients had lower incidence and mortality from COVID-19 compared to those with lung, colorectal, or bladder cancers.

## Abstract

Cancer patients are more vulnerable to SARS-CoV-2 and COVID-19 due to their immunocompromised status. This study assessed the risk of infection, prevalence, and mortality in cancer patients during the first wave of COVID-19 in Parma, Italy, from February to June 2020. A retrospective analysis of 40,148 cancer patients was conducted, examining cancer subtype, treatment status, and COVID-19 diagnosis. The results showed that cancer patients had a significantly higher risk of infection (OR 1.67, p < 0.001). Those on active cancer treatment had a higher risk of all-cause death (HR 1.83, p < 0.000268). Cancer subtype influenced COVID-19 outcomes, with breast cancer patients experiencing lower incidence and mortality compared to those with lung, colorectal, or bladder cancers. The findings highlight the need for tailored prevention strategies, prioritizing vaccination and managing cancer treatments during pandemics to mitigate risks for cancer patients.

Background/objectives: Cancer patients are more vulnerable to SARS-CoV-2 infection and COVID-19 due to their immunocompromised status. This study aims to evaluate the risk of SARS-CoV-2 infection, as well as COVID-19 prevalence and mortality, in cancer patients during the first wave of the COVID-19 pandemic in a virus epicenter of Northern Italy. Methods: This retrospective analysis included 40,148 prevalent cancer patients from the province of Parma, Italy, between February and June 2020. Patients were identified from health system records and classified by cancer subtype, treatment status, and COVID-19 diagnosis. The risk of infection and mortality was analyzed using odds ratios (OR) and hazard ratios (HR). Results: Among cancer patients, those on active cancer treatment had a higher cumulative risk of all-cause death (HR 1.83, p < 0.000268). Cancer subtype significantly impacted COVID-19 outcomes, with breast cancer patients showing lower incidence and mortality compared to those with lung, colorectal, or bladder cancers. Conclusions: Cancer patients, especially those on active treatment, are at increased risk of COVID-19 infection and death. Tailored prevention strategies, including prioritization of vaccination and careful management of cancer treatments, are crucial to mitigate risks during pandemics. These findings provide valuable insights for clinical decision-making in oncological care during public health crises.