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2020 ; 395
(10241
): 1919-1926
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COVID-19 mortality in patients with cancer on chemotherapy or other anticancer
treatments: a prospective cohort study
#MMPMID32473682
Lee LY
; Cazier JB
; Angelis V
; Arnold R
; Bisht V
; Campton NA
; Chackathayil J
; Cheng VW
; Curley HM
; Fittall MW
; Freeman-Mills L
; Gennatas S
; Goel A
; Hartley S
; Hughes DJ
; Kerr D
; Lee AJ
; Lee RJ
; McGrath SE
; Middleton CP
; Murugaesu N
; Newsom-Davis T
; Okines AF
; Olsson-Brown AC
; Palles C
; Pan Y
; Pettengell R
; Powles T
; Protheroe EA
; Purshouse K
; Sharma-Oates A
; Sivakumar S
; Smith AJ
; Starkey T
; Turnbull CD
; Várnai C
; Yousaf N
; Kerr R
; Middleton G
Lancet
2020[Jun]; 395
(10241
): 1919-1926
PMID32473682
show ga
BACKGROUND: Individuals with cancer, particularly those who are receiving
systemic anticancer treatments, have been postulated to be at increased risk of
mortality from COVID-19. This conjecture has considerable effect on the treatment
of patients with cancer and data from large, multicentre studies to support this
assumption are scarce because of the contingencies of the pandemic. We aimed to
describe the clinical and demographic characteristics and COVID-19 outcomes in
patients with cancer. METHODS: In this prospective observational study, all
patients with active cancer and presenting to our network of cancer centres were
eligible for enrolment into the UK Coronavirus Cancer Monitoring Project
(UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near
real-time reports to frontline doctors about the effects of COVID-19 on patients
with cancer. Eligible patients tested positive for severe acute respiratory
syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded
patients with a radiological or clinical diagnosis of COVID-19, without a
positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge
from hospital, as assessed by the reporting sites during the patient hospital
admission. FINDINGS: From March 18, to April 26, 2020, we analysed 800 patients
with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a
mild COVID-19 disease course. 226 (28%) patients died and risk of death was
significantly associated with advancing patient age (odds ratio 9·42 [95% CI
6·56-10·02]; p<0·0001), being male (1·67 [1·19-2·34]; p=0·003), and the presence
of other comorbidities such as hypertension (1·95 [1·36-2·80]; p<0·001) and
cardiovascular disease (2·32 [1·47-3·64]). 281 (35%) patients had received
cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After
adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks
had no significant effect on mortality from COVID-19 disease, when compared with
patients with cancer who had not received recent chemotherapy (1·18 [0·81-1·72];
p=0·380). We found no significant effect on mortality for patients with
immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the
past 4 weeks. INTERPRETATION: Mortality from COVID-19 in cancer patients appears
to be principally driven by age, gender, and comorbidities. We are not able to
identify evidence that cancer patients on cytotoxic chemotherapy or other
anticancer treatment are at an increased risk of mortality from COVID-19 disease
compared with those not on active treatment. FUNDING: University of Birmingham,
University of Oxford.
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