Publication date: Dec 01, 2024

Limited research exists on the risks and spectrum of complications in post-acute phase of COVID-19 in cancer patients. This study aimed to evaluate the post-acute effects of COVID-19 on different types of morbidities among cancer patients across two regions with different healthcare systems and dominant variants of COVID-19. Cancer patients with COVID-19 from the UK Biobank (UKB, n = 2230; March 16, 2020 to May 31, 2021; pre-Omicron-variants dominant) and electronic medical records in Hong Kong (HK cohort, n = 22,335; April 1, 2020 to October 31, 2022; Omicron-variant dominant) were included. Each COVID-19 case was randomly matched with up to 10 non-COVID-19 cancer patients based on age and sex. Follow-up lasted until 31 August 2021 for UKB and 23 January 2023 for HK. Inverse probability treatment weighting balanced cohort characteristics. Cox regression evaluated the association of COVID-19 with morbidities occurred 30 days post-infection. Cancer patients with COVID-19 consistently showed significantly higher risk of major cardiovascular diseases (CVDs) [UKB: hazard ratio [HR] 1. 8 (95% CI 1. 3, 2. 5); HK: HR 1. 4 (95% CI 1. 1, 1. 8)], CVD death [UKB: HR 4. 3 (95% CI 2. 9, 6. 2); HK: HR 1. 7 (95% CI 1. 3, 2. 4)], and all-cause mortality [UKB: HR 4. 7 (95% CI 4. 0, 5. 5); HK: HR 1. 6 (95% CI 1. 5, 1. 7)] in both cohorts despite the difference in dominant variants. Cancer patients at advanced ages or severely infected had higher all-cause mortality risk. However, associations between COVID-19 and CVDs became insignificant for fully vaccinated patients. COVID-19 infection is associated with increased risks of CVDs and mortality in cancer patients. Fully vaccination may reduce the post-acute effects of COVID-19 on CVDs. This information may guide effective pre-emptive measures to reduce COVID-19-related morbidities and mortality in cancer patients.

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