key: cord-0078234-8guimmnb
authors: Sena, Gabrielle R.; Lima, Jurema T.O.; Lima, Tiago P.F.; Vidal, Suely A.; Sales, Mozart J.T.; Goes, Paulo S.A.; Mello, Maria Julia G.
title: Inequity in inequity: Disproportional mortality risk in patients with cancer with COVID-19 in Brazil - a call to action
date: 2022-05-17
journal: J Geriatr Oncol
DOI: 10.1016/j.jgo.2022.05.003
sha: ef7a70b6439e9d7fbb3e348517226321b7817022
doc_id: 78234
cord_uid: 8guimmnb

nan

Gabrielle R. Sena 1,5,* gabriellesena8@gmail.com, Jurema T. O. Lima 1 , Tiago P. F. In patients with cancer, lethality is higher than reported in other studies 3 (confirmed by reverse transcription-polymerase chain reaction), and notified in FormSUS between March 07, 2020 and May 08, 2021 were included in the study (Fig 1) . Age, sex, race, comorbidities, history and type of cancer, topography of primary tumor, and COVID-19 were included in the analysis. Being overweight (aOR 0.50; 95%CI 0.23-1.10; p=0.087) and having a cough as a COVID-19 symptom (aOR 0.57; 95% I 0.40-0.83; p=0.003) were protective factors (Table 1) .

First, the highest lethality in patients with cancer draws attention because it is disproportionally higher than other studies, even in hospitalized environments. 5 This could be partially explained by characteristics of the studied population (patients with cancer and SARS due to COVID-19), magnitude of the disease, and associated risk factors 5 .

Second, we observed that age increased the chance of death by 2% for each year of life, and lethality was higher in patients aged ≥80 years. This age group has the highest growth rate in Brazil and worldwide. However, we believe mortality by cancer in very old individuals tends to decrease or stabilize either by biological phenomenon or lack of notification in cancer registries 6 . Although the COVID-19 pandemic reduced life expectancy by 1.31 years in Brazil, 7 the J o u r n a l P r e -p r o o f impact of COVID-19 in elderly individuals must also consider interactions among income inequality, poverty, and access to healthcare infrastructure (e.g., availability of physicians and hospital beds).

Aging is associated with a number of comorbidities, including cancer, while chronic diseases are risk factors for severe COVID-19. Although chronic pulmonary diseases are not very frequent comorbidities in COVID-19 patients, they were associated with high lethality in patients with cancer with COVID-19 and the general population. 8 Third, overweight patients with COVID-19 present more severe symptoms and high risk of death 9 ; however, this might not be true in patients with cancer. We observed that being overweight was a protective factor, probably because muscle, fat reserve, or both contributed to reducing the impacts of sarcopenia/cachexia, improving prognosis.

Lastly, having a cough as a COVID-19 symptom was also a protective factor for patients with cancer in our study. Perhaps this could be explained because in the presence of cough, the patient may seek medical care early. This symptom is highly prevalent in critically ill patients hospitalized due to COVID-19 10 and patients with cancer. Therefore, it should be considered an objective alert for patients and caregivers seek healthcare. The fight against diseases such as cancer, COVID-19, or both, demands that the healthcare system prioritize humanitarian questions. Therefore, recognition of this unequal fight is needed, especially in developing countries.

Further evidence is required to assess the impacts of signs/symptoms, other 

Mortes de COVID-19 na América Latina 2021, por país

Ministério da Saúde do Brasil. COVID-19 Painel Coronavírus

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

Nosocomial infections in patients with cancer

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

Aging and the cancer burden in Latin America and the Caribbean: Time to act

Reduction in life expectancy in Brazil after COVID-19

Chronic obstructive pulmonary disease and the COVID-19 pandemic: Reciprocal challenges

Obesity is a risk factor for developing critical condition in COVID-19 patients: A systematic review and meta-analysis