Dying from cancer with COVID-19: age, sex, socio-economic status, and comorbidities

Abstract

Background

The COVID-19 pandemic has caused excess deaths (all causes) and has disproportionately affected the elderly with certain characteristics.

Objectives

To study how COVID-19 affected cancer deaths regarding age, sex, socio-economic status, comorbidities, and access to palliative care. An additional objective was to study changes in place of care and death.

Material and methods

A descriptive, retrospective study of all cancer patients who died during March–May 2020 in the Stockholm region, n = 1467 of which 278 died with a COVID-19 diagnosis, compared with deaths in 2016–2019. The Stockholm Regional Council’s central data warehouse was used. T-tests, 95% CI, Wilcoxon and chi-squared tests were used for comparisons.

Results

There were excess cancer deaths compared with 2016–2019 (p < 0.001) and patients dying with a COVID-19 diagnosis were older (79.7 vs. 75.9 years, p < 0.0001), more often male (67% vs. 55%, p < 0.0001), and had more comorbidities (Charlson Comorbidity Index 1.6 vs. 1.1, p < 0.0001). Patients with COVID-19 more seldom had access to palliative care (34% vs. 59%, p = 0.008), had more changes in place of care during the last two weeks of life (p < 0.0001) and died more often in acute hospitals (34% vs. 14%, p < 0.0001). For the subgroup with access to palliative care, the hospital deaths for individuals with and without a COVID-19 diagnosis were 11% and 4%, respectively (p = 0.008).

Conclusion

Cancer patients dying with a COVID-19 diagnosis were older, more often male, and had more comorbidities. A COVID-19 diagnosis negatively affected the probability of being admitted to specialized palliative care and increased the likelihood of dying in an acute hospital.