Characterizing the Experience of SARS-CoV-2 In CoVHORT Participants with A History of Cancer

Abstract

Cancer is the second leading cause of death in the United States, accounting for approximately 600,000 deaths annually. While overall cancer incidence has declined due to advances in treatment, early detection, and reduced smoking rates, the number of individuals living with a history of cancer continues to grow. The immunologic consequences of cancer and its treatment may influence susceptibility to infectious diseases, such as COVID-19.The SARS-CoV-2 pandemic, which began in late 2019, continues to affect global populations. COVID-19 primarily presents as a respiratory illness but can involve inflammatory, cardiovascular, neurologic, and dermatologic symptoms. Although vaccinations and therapies have since reduced transmission and mortality, limited understanding of the virus and a lack of available treatments in the early pandemic posed heightened risks, particularly for potentially vulnerable populations like those with a history of cancer. The aim of this dissertation was to examine how the COVID-19 pandemic impacted individuals with a history of cancer, using data from the Arizona COVID-19 Cohort Study (CoVHORT), initiated in May 2020. Aim 1 characterized self-reported symptom profiles and illness severity among CoVHORT participants, stratified by cancer history. Symptom differences were evaluated using proportion tests, and disease severity was modeled using multinomial logistic regression. Participants with a history of cancer reported fewer symptoms on average (4.29 vs. 4.63; p = 0.01) and slightly lower severity. These findings suggest that although symptom manifestations were broadly similar, individuals with a cancer history may have experienced a less severe course of illness by self-reported metrics. Aim 2 assessed perceived stress using the 10-item Perceived Stress Scale (PSS-10) at baseline, comparing those with and without a cancer history. Mann-Whitney U tests were used for individual item differences, and a probit model, weighted by age, was used to examine perceived stress tertiles (mild, moderate, severe). Results suggested that a history of cancer was associated with a lower likelihood of reporting moderate (β = -0.13, 95% CI: -0.43 to 0.17) and severe (β = -0.47, 95% CI: -0.80 to -0.15) stress, indicating a potential psychological resilience among cancer survivors early in the pandemic. Aim 3 examined COVID-19 infection risk over time as a function of cancer history and engagement with public health mitigation strategies (e.g., masking, distancing). Differences in strategy endorsement were assessed with two-tailed t-tests. A Cox proportional hazards model was used to assess infection risk by cancer status and public health behavior, including potential effect modification by vaccination. No statistically significant difference in infection hazard was observed between those with and without a history of cancer in the adjusted model (HR: 0.64, 95% CI: 0.20–2.09) or in a sensitivity analysis excluding non-melanoma skin cancers (HR: 0.59, 95% CI: 0.14–2.54). Vaccination was strongly protective against COVID infection in these models. Together, these findings suggest that individuals with a history of cancer may exhibit a degree of resilience in the face of the COVID-19 pandemic—reporting similar or lower symptom burden, stress, and infection risk compared to their peers without cancer. These results may inform future public health messaging for cancer survivors and highlight their potential role as informed advocates within their communities. Further research, including qualitative exploration of cancer survivors’ lived experiences during the pandemic, is warranted to contextualize and deepen understanding of these findings.