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COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

Our take —

This study showed high mortality among cancer patients with COVID-19 in the UK. Mortality was associated with known risk factors for COVID-19 mortality, including older age and comorbidities. There was no evidence of a positive association between non- palliative chemotherapy or other anticancer treatment and mortality due to COVID-19. COVID-19 prevention efforts among cancer patients should continue to be prioritized given the high mortality overall. This study suggests that oncologists should not withhold cancer treatment due to fear of increasing COVID-19 mortality. Larger multi-country prospective cohorts of cancer patients are needed to further evaluate this question, and to evaluate potential heterogeneity in outcomes across different cancer types, treatments and populations.

Study design

Prospective Cohort

Study population and setting

The primary objective of the study was to evaluate whether there were any differences in all-cause mortality, or hospital discharge, among COVID-19 patients with cancer who are on anticancer treatment (cytotoxic chemotherapy or other therapies) compared to cancer patients who are not on cancer treatment. This study analyzed data of all patients with active cancer diagnosed with COVID-19 using RT-PCR in 55 centers in the UK between March 18 and April 26, 2020. These centers were part of the UK Coronavirus Cancer Monitoring Project (UKCCMP), a national initiative established in March 2020 to prospectively collect relevant data on COVID-19 patients with cancer.

Patient-level data were collected on relevant demographic and clinical information, including age and presence of comorbidities, cancer type (localized vs. metastatic) and stage, and cancer treatment history, specifically history of chemotherapy, immunotherapy, hormonal therapies, or radiotherapy within 4 weeks SARS-CoV-2 infection.

Summary of Main Findings

Overall 800 symptomatic and laboratory-confirmed COVID-19 patients were enrolled. The most common cancer types involved digestive organs (19%), hematological (14%), and breast (13%). Of these, 43% had metastatic cancer, while 19% had primary localized tumors. The vast majority (79%) of participants had other comorbidities apart from cancer including cardiovascular disease, hypertension, and diabetes. Half (52%) had mild COVID-19 disease, 39% required oxygen and 7% were admitted to an intensive therapy unit (ITU).

Overall, 28% (226) of the patients died, and 93% of those deaths were attributed to COVID-19. Mortality among patients in ITU was around 43%. Factors positively associated with mortality were older age (adjusted OR) aOR: 9.42 (6.56–10.02), having at least one comorbidity including cardiovascular disease 2.32 (1.47–3.64) or hypertension 1.95 (1.36–2.80), being male and having severe COVID-19 disease. There was no apparent difference in mortality comparing cancer patients on any anticancer treatment in the 4 weeks prior to COVID-19 infection versus cancer patients not on treatment.

Study Strengths

The study is a multi-center nationwide prospective cohort of cancer patients with laboratory-confirmed COVID-19 in the UK. The data collection process was rigorous, in real time and included important clinical and demographic variables that were adjusted for in the analyses.

Limitations

There is potential of selection bias. Symptomatic individuals requiring medical attention may be overrepresented which may in part explain the high overall mortality. The true burden of SARS-COV2 among cancer patients can also not be estimated with these data. Furthermore, the number of patients on non-chemotherapy cancer therapies was small, warranting caution when interpreting findings of these smaller groups.

Value added

Before this study, there was mixed evidence from small studies on the association of cancer treatment and COVID-19 morbidity and mortality. This is the largest prospective cohort study to date evaluating whether chemotherapy or other anticancer treatment are associated with higher mortality among cancer patients with COVID-19. The findings provide valuable data that can inform clinical decision making for cancer patients in the near future.

This review was posted on: 9 June 2020