Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer

Elkrief, A. et al. (2022). Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer. The Lancet Health Longevity. DOI:https://doi.org/10.1016/S2666-7568(22)00009-5

The researchers’ primary objective at the outset of this study was to determine whether a measure of geriatric risk could capture risk of severe clinical outcomes among older patients with cancer and COVID-19. Additionally, they also sought to describe the presentation, complications and effect of COVID-19 on subsequent cancer care among older adults with cancer.

Patients of 60 years of age and above who were categorised as high risk- using a novel geriatric risk index comprising age, performance status and commodities- had significantly higher COVID-19 severity, including hospitalisation, need for intensive care and mechanical ventilation, and death, within 30 days due to any cause than patients categorised as standard risk or intermediate risk (Source: Elkrief et al, 2022).

Elkrief and colleagues’ study examines the relationship between their novel geriatric risk index and adverse outcomes from COVID-19 among older adults with cancer, as well as the frequency of atypical presentations in this population.

Summary

Background

Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.

Methods

In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95 per cent CIs were estimated from ordinal and binary logistic regression models.

Findings

5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22–120), and median age was 72 years (IQR 66–79). The CCC19 geriatric risk index identified 2365 (41·7 per cent) patients as standard risk, 2217 (39·1 per cent) patients as intermediate risk, and 1089 (19·2 per cent) as high risk. 36 (0·6 per cent) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95 per cent CI 6·20–8·45). 920 (16·2 per cent) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8 per cent) of 2365 standard-risk patients, 409 (18·5 per cent) of 2217 intermediate-risk patients, and 350 (32·1 per cent) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95 per cent CI 8·54–13·5) than standard-risk patients.

Interpretation

The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.

Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium [paper]

Amount and intensity of leisure-time physical activity and lower cancer risk

Matthews, C. E. et al. | Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk | Journal of Clinical Oncology | published online December 26th 2019.

Purpose
To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.

Methods
Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).

Results
A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.

Conclusion
Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.

Full document available at Journal of Clinical Oncology

Cancer survivors have raised heart risk, reports a US population-based study of cardiovascular disease mortality risk patients with cancer

Sturgeon, K.M , et al | 2019| A population-based study of cardiovascular disease mortality risk in US cancer patients| European Heart Journal| ehz766| https://doi.org/10.1093/eurheartj/ehz766

The European Heart Journal has published research that looked at three million US patients, across 28  types of  cancers, over a period of  40 years, the experts behind this analysis found that more than one-tenth of patients died from cardiovascular diseases. The research highlights the incidence of cardiovascular disease (CVD)  in patients diagnosed with breast, prostate, or bladder cancer.  The team also observed that from the point of cancer diagnosis onward patients with cancer (all sites) are at elevated risk of dying from CVDs compared to the general US population (Source: Sturgeon, et al. 2019).

 

The journal article is available in full from The European Heart Journal

Abstract

Aims

 

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

 

Methods and results

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973–2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at less than 35 years of age. Further, CVD mortality risk is highest  within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

Conclusion

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

 

In the news:

BBC News Cancer survivors ‘have higher heart risk’

Excess weight and cancer risk

New figures from Cancer Research UK show that people who are obese now outnumber people who smoke two to one in the UK, and excess weight causes more cases of certain cancers than smoking.

Almost a third of UK adults are obese and, while smoking is still the nation’s biggest preventable cause of cancer and carries a much higher risk of the disease than obesity, Cancer Research UK’s analysis revealed that being overweight or obese trumps smoking as the leading cause of four different types of cancer.

Excess weight causes around 1,900 more cases of bowel cancer than smoking in the UK each year. The same worrying pattern is true of cancer in the kidneys (1,400 more cases caused by excess weight than by smoking each year in the UK), ovaries (460) and liver (180).

The charity wants the Government to act on its ambition to halve childhood obesity rates by 2030 and introduce a 9pm watershed for junk food adverts on TV and online, alongside other measures such as restricting promotional offers on unhealthy food and drinks.

Full story: Obese people outnumber smokers two to one| Cancer Research UK

See also: Obesity ’causes more cases of some cancers than smoking’ | BBC News

Obesity is second biggest cause of cancer after smoking

Obesity is the biggest preventable cause of cancer after smoking with around 22,800 cases of cancer in the UK caused by excess body weight every year | Cancer Research UK

Image source: cancerresearchuk.org

Cancer Research UK has produced a resource containing answers to common questions from patients, tips on how to discuss weight management with patients who are overweight or obese and a campaign poster.

Free copies can be ordered from the Cancer Research UK website, where pharmacists and pharmacy staff can also sign up to receive future copies of the Cancer Insight newsletter.

How diet, nutrition and physical activity affect cancer risk

The World Cancer Research Fund have published an interactive infographic summarising risk factors for certain cancers.

The full report summarises the wealth of evidence on how diet, nutrition and physical activity can influence the biological processes that underpin the development and progression of cancer.

The report contains the following 10 exposure sections, covering definitions and background information, issues relating to interpretation of the evidence, the evidence itself ( and judgements on the evidence.

• Wholegrains, vegetables and fruit
• Meat, fish and dairy products
• Preservation and processing of foods
• Non-alcoholic drinks
• Alcoholic drinks
• Other dietary exposures
• Physical activity
• Body fatness and weight gain
• Height and birthweight
• Lactation

View the Interactive Cancer Risk Matrix

Full report: Diet, Nutrition, Physical Activity and Cancer: a Global Perspective

The association of lifetime alcohol use with mortality and cancer risk in older adults

The risk of mortality, and of developing a number of cancers, is lowest in light drinkers consuming an average of less than one drink per day across their lifetime, and the risk of some cancers increases with each additional drink per week, according to a new study.

Abstract

Background
While current research is largely consistent as to the harms of heavy drinking in terms of both cancer incidence and mortality, there are disparate messages regarding the safety of light-moderate alcohol consumption, which may confuse public health messages. We aimed to evaluate the association between average lifetime alcohol intakes and risk of both cancer incidence and mortality.

Methods and findings
We report a population-based cohort study using data from 99,654 adults (68.7% female), aged 55–74 years, participating in the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cox proportional hazards models assessed the risk of overall and cause-specific mortality, cancer incidence (excluding nonmelanoma skin cancer), and combined risk of cancer and death across categories of self-reported average lifetime alcohol intakes, with adjustment for potential confounders.

During 836,740 person-years of follow-up (median 8.9 years), 9,599 deaths and 12,763 primary cancers occurred. Positive linear associations were observed between lifetime alcohol consumption and cancer-related mortality and total cancer incidence. J-shaped associations were observed between average lifetime alcohol consumption and overall mortality, cardiovascular-related mortality, and combined risk of death or cancer.

In comparison to lifetime light alcohol drinkers (1–3 drinks per week), lifetime never or infrequent drinkers (<1 drink/week), as well as heavy (2–<3 drinks/day) and very heavy drinkers (3+ drinks/day) had increased overall mortality and combined risk of cancer or death. This analysis is limited to older adults, and residual confounding by socioeconomic factors is possible.

Conclusions
The study supports a J-shaped association between alcohol and mortality in older adults, which remains after adjustment for cancer risk. The results indicate that intakes below 1 drink per day were associated with the lowest risk of death.

Full reference: Kunzmann, A. T. et al. | The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study | PLOS Medicine | June 19, 2018
See also: ScienceDaily | Risks of cancer and mortality by average lifetime alcohol intake

Impact of chronic diseases on cancer risk

Several common chronic diseases together account for more than a fifth of new cancer cases and more than a third of cancer deaths| BMJ | via ScienceDaily

Findings from research published in the BMJ show that the cancer risks from common chronic diseases, such as heart disease and diabetes, are as important as those from five major lifestyle factors combined.

A team of researchers  investigated the combined effect of eight common chronic diseases or disease markers on cancer risk compared with lifestyle factors. Among the conditions evaluated were cardiovascular disease, diabetes, chronic kidney disease, pulmonary disease, and gouty arthritis.

The researchers found that cardiovascular disease markers, diabetes, chronic kidney disease markers, pulmonary disease, and gouty arthritis marker were individually associated with risk of developing cancer or cancer death.

Together, these chronic diseases and markers accounted for more than one fifth of all new cancers and more than one third of all cancer deaths in this study population, which was similar to the contribution of five major lifestyle risk factors combined — smoking, insufficient physical activity, insufficient fruit and vegetable intake, alcohol consumption, and obesity.

The researchers also found that physical activity was associated with a nearly 40% reduction in the excess risks of cancer and cancer death associated with chronic diseases and markers.

However, the authors point out that chronic diseases are not targeted in current cancer prevention strategies — and say their findings have important implications for developing new strategies that target chronic diseases.

Full detail at ScienceDaily

Full reference: Huakang Tu et al. |  Cancer risk associated with chronic diseases and disease markers: prospective cohort study | BMJ 2018

Eating plenty of wholegrains cuts your risk of bowel cancer, according to a new report.

Wholegrains and bowel cancer – what you need to know | CRUK

Eating plenty of wholegrains cuts your risk of bowel cancer, according to a new report. And it seems we can reap the benefits without making wild changes to our diets .

The news comes from a report produced by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR), outlining the latest evidence on how we can reduce our risk of bowel cancer.

It focusses on the effects of diet, weight, physical activity and alcohol on bowel cancer risk. And with bowel cancer being the fourth most common cancer in the UK, finding ways to reduce our risk of the disease are important.

The WCRF studies all the evidence on a potential cause of cancer and decides whether that evidence is strong enough to support recommendations on ways we can reduce our risk.

• Overview via Cancer Research UK
• Original research report

How the alcohol industry mislead the public about alcohol and cancer

Alcohol consumption increases the risk of several types of cancer, including several common cancers | Drug and Alcohol Review

As part of their corporate social responsibility activities, the alcohol industry (AI) disseminates information about alcohol and cancer. We examined the information on this which the AI disseminates to the public through its ‘social aspects and public relations organizations’ and related bodies. The aim of the study was to determine its comprehensiveness and accuracy.

Most of the organisations were found to disseminate misrepresentations of the evidence about the association between alcohol and cancer. Three main industry strategies were identified:

1.  denial/omission: denying, omitting or disputing the evidence that alcohol consumption increases cancer risk.
2. distortion: mentioning cancer, but misrepresenting the risk.
3. distraction: focussing discussion away from the independent effects of alcohol on common cancers. Breast cancer and colorectal cancer appeared to be a particular focus for this misrepresentation.

Full reference: Petticrew, M. et al. (2017) How alcohol industry organisations mislead the public about alcohol and cancer. Drug and Alcohol Review. Published online: 7 Septmeber 2017