Abstract 3590: Survival among individuals diagnosed with cancer during the COVID-19 pandemic in the United States

Background: The COVID-19 pandemic has impacted cancer outcomes, but research on its impact on survival outcomes, especially cause-specific death across different cancer types and socioeconomic factors, is limited. Methods: Individuals diagnosed in 2019 and 2020 with one of 14 types of cancer at ages 20-89 in 17 Surveillance, Epidemiology, and End Results registries were included. We used Cox proportional hazards model to compare the risk of death from all causes, cancer, and COVID-19 within the first year of diagnosis between cases from 2020 vs 2019, adjusting for demographic factors and socioeconomic status. Additionally, for 2020 cases, Cox models were used to identify risk factors for COVID-19, cancer, and all causes death. Results: Compared to 2019 cases (N=274,605), 2020 cases (N=248,840) had a higher risk of death from all causes and COVID-19 for each of the 14 types of cancer, while increased risks of cancer-specific death were limited to cases with 8 of 14 cancer types. Highest hazard ratios (HRs) were estimated among those with cancers of the thyroid (HR=1.57, 95%CI: 1.42-1.72) and prostate (HR=1.51, 95% CI:1.44-1.58) for all-cause death; among those with leukemia (HR=11.42, 95%CI: 6.31-20.64) and lung (HR=6.58, 95%CI:5.02-8.62) cancers for COVID-19 death; and among those with colorectal (HR=1.15, 95%CI:1.10-1.20) and breast (HR=1.12, 95%CI:1.04-1.21) cancers for cancer-specific death. Among 2020 cases, cancer-specific death and Covid-19 death showed distinct patterns in racial/ethnic and urban/rural disparities (Table 1 Table 1: Association of patients characteristics with the risk of death from all-cause, cancer-speci Risk factors (reference group) All-cause Adjusted HR (95% CI) cancer-specific Adjusted HR (95% CI) covid-related Adjusted HR (95% CI) Age (ref: 20-39 y) 40-49 y 1.35 (1.25-1.45) 1.71 (1.50-1.96) 1.51 (0.74-3.09) 50-59 y 1.42 (1.33-1.52) 2.36 (2.10-2.66) 2.65 (1.42-4.97) 60-69 y 1.60 (1.50-1.71) 3.07 (2.73-3.45) 4.79 (2.61-8.79) 70+ y 2.23 (2.10-2.38) 4.49 (4.00-5.04) 8.26 (4.52-15.11) Race (ref: Non-Hispanic White) Hispanic 1.42 (1.38-1.46) 1.00 (0.96-1.05) 1.91 (1.62-2.25) Non-Hispanic American Indian/Alaska Native 1.13 (1.00-1.27) 1.03 (0.88-1.20) 1.36 (0.64-2.86) Non-Hispanic Asian or Pacific Islander 1.20 (1.16-1.25) 1.02 (0.97-1.07) 1.16 (0.90-1.49) Non-Hispanic Black 1.12 (1.08-1.16) 1.08 (1.04-1.13) 1.73 (1.44-2.07) Urban/Rural (ref: Nonmetropolitan) Counties in metropolitan areas with >1 million population 1.02 (0.98-1.06) 0.89 (0.85-0.94) 1.30 (1.02-1.66) Counties in metropolitan areas with less than 1 million population 0.98 (0.95-1.02) 0.94 (0.90-0.98) 1.21 (0.96-1.52) Sex (ref: Female) Male 1.04 (1.02-1.06) 1.04 (1.01-1.07) 1.16 (1.00-1.34) Income (ref: Upper income level) Low 1.28 (1.23-1.33) 1.27 (1.21-1.34) 1.80 (1.40-2.31) Middle 1.13 (1.10-1.15) 1.13 (1.09-1.16) 1.57 (1.34-1.84) Stage (Ref: Stage 1) Stage 2 1.41 (1.35-1.46) 2.13 (1.98-2.28) 1.44 (1.15-1.81) Stage 3 2.22 (2.13-2.31) 4.22 (3.96-4.50) 1.95 (1.55-2.46) Stage 4 3.22 (3.10-3.35) 6.84 (6.45-7.26) 1.82 (1.44-2.31) ). Specifically, individuals living in large metropolitan areas and those identifying as Hispanic were found to be at higher risk of death from COVID-19, but not from cancer. Conclusion: The Covid-19 pandemic’s impact on survival of individuals with cancer varied by cause of death, cancer type, and socioeconomic factors, highlighting the need for targeted healthcare interventions to ensure equitable care and reduced mortality. Citation Format: Chenxi Jiang, Xuesong Han, Ahmedin Jemal, Hyuna Sung. Survival among individuals diagnosed with cancer during the COVID-19 pandemic in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3590.