Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19
Csilla Várnai, Claire Palles, Roland Arnold, Helen Curley, Karin Purshouse, Vinton W.T. Cheng, Stephen Booth, Naomi Campton, Graham P. Collins, D.J. Hughes, Austin Kulasekararaj, Alvin Lee, Anna Olsson‐Brown, Archana Sharma‐Oates, Mieke Van Hemelrijck, Lennard Y. W. Lee, Rachel Kerr, Gary Middleton, Jean‐Baptiste Cazier, UKCCMP Team, S. Pugh, Pippa Corrie, Ahmed Bedair, Madeleine Hewish, Pauline Leonard, Jack Illingworth, Stephen P. Hibbs, Nicolaos Diamantis, Samah Massalha, Claire Fuller, Caroline Usbourne, Duncan C. Gilbert, Jennifer Davies, Tom Newsom‐Davis, Rachel Sharkey, Rebecca Lee, Ann Tivey, Rohan Shotton, Clare Griffin, Laura Horsley, Simon Shamas, Joseph J. Sacco, Madbuba Choudhury, Jillian Noble, Heather Shaw, Rachel Bolton, Ana Ferreira, Peter S Hall, Paul Ramage, Jaishree Bhosle, Alison Massey, Michaela Hill, Leena Mukherjee, Aisha Ghaus, Sarah Derby, Sean Brown, Sarah Lowndes, Saorise Dolly, Beth Russell, Charlotte Moss, Daniel J. Müller, Annet Pillai, Shakeel Lowe, Lucy Cook, Christopher Scrase, R. Jyothirmayi, Ruth Board, Stephanie Cornthwaite, Shefail Parikh, Emma Cattell, Nicola Cox, Abigail Gault, Sam Moody, Caroline Dobeson, Mark Baxter, Tom Roques, Alexander Pawsey, Roderick Oakes, Lucinda Melcher, Olivia Chan, Sarah Ayers, Helen Bowyer, Mohammed Althohami, Sajjan Mittal, Laura Feeney, Avinash Aujayeb, Omar Sheikh, Sangary Kathirgamakarthigeyan, Victoria K. Woodcock, Francesca Holt, Simon Wyatt, Oliver Topping, Michaël Tilby, Madhumita Bhattacharyya, Emma Burke, Shawn Ellis, Joseph Chacko, Taslima Rabbi, Michael Rowe, Rebecca Sargent
Abstract
Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19-related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.