Impact of the COVID-19 Pandemic on Inpatient Cancer Treatment and Outcomes in the United States

Objective To determine how hospitalized cancer patients were impacted by the pandemic. Patients and Methods Inpatients with a primary or secondary cancer diagnosis in the United States were identified using International Classification of Diseases, Tenth Revision, codes. Over 414,000 (210,000 weighted) cancer admissions were reported on the National Inpatient Sample database from 2019 to 2021 and used for analysis. Patients were stratified by COVID-19 status and sociodemographic factors. Primary outcomes included in-hospital complications, discharge disposition, and in-hospital mortality. Key subgroups included income quartiles and insurance type. Results Cancer patient admissions declined by 10.2% (75,150) from 2019 to 2020, whereas odds of in-hospital mortality decreased 9% (OR, 0.91; 95% CI, 0.87-0.94; P<.001). Drug-induced hematologic complications increased from 9.56% (70,207/734,385) to 10.2% (69,338/679,780; P<.001) and adverse effects and poisoning increased from 6.18% (45,385/734,385) to 6.86% (46,633/679,780; P<.001). COVID-19 patients experienced more drug-induced hematologic complications (9.87% [203,709/2,063,920] vs 16.3% [1545/9480]; P<.001), infectious (3.08% [63,569/2,063,920] vs 6.70% [635/9480]; P<.001), and thromboembolic events (2.79% [57,583/2,063,920] vs 5.01% [475/9480]; P<.001). The highest income quartile had 11% lower odds of in-hospital death than the lowest income quartile (OR, 0.89; 95% CI, 0.85-0.93; P<.001). Self-paying patients had 41% greater odds of in-hospital death than Medicare patients (OR, 1.41; 95% CI, 1.26-1.57; P<.001). Conclusion Fewer cancer patients were admitted, and they experienced greater complications. Low-income, self-pay, as well as Black, Asian or Pacific Islander, and Other race patients, had higher odds of mortality. Overall in-hospital mortality for cancer patients decreased over the pandemic, possibly indicating change in place of death. Meanwhile, COVID-19–positive patients experienced more complications and increased in-hospital mortality. These findings emphasize the need for resilient and equitable health care systems to maintain essential services during crises.