Abstract
BackgroundThe COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond. It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19.MethodsWe included patients at a London tertiary hospital with laboratory confirmed SARS-CoV-2 infection. All patients with a history of solid cancer were included. Age- and sex-matched patients without cancer were randomly selected. Patients with hematological malignancies were excluded.ResultsWe identified 94 patients with cancer, matched to 226 patients without cancer. After adjusting for age, ethnicity, and co-morbidities, patients with cancer had increased mortality following COVID-19 (HR 1.57, 95% CI:1.04–2.4, p = 0.03). Increasing age (HR 1.49 every 10 years, 95% CI:1.25–1.8, p < 0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73–4.9, p < 0.001), and cerebrovascular disease (HR 1.93, 95% CI:1.18–3.2, p = 0.008) also predicted mortality. Within the cancer cohort, systemic anti-cancer therapy (SACT) within 60 days of COVID-19 diagnosis was an independent risk factor for mortality (HR 2.30, 95% CI: 1.16–4.6, p = 0.02).ConclusionsAlong with known risk factors, cancer and SACT confer an independent risk for mortality following COVID-19. Further studies are needed to understand the socio-economic influences and pathophysiology of these associations.
Highlights
The Coronavirus disease 2019 (COVID-19) global pandemic caused by the SARS-CoV-2 virus necessitated urgent and pragmatic measures to protect the most vulnerable people in society, including those with cancer
626 patients with laboratory confirmed SARS-CoV-2 infection between 1 March 2020 and 31 May 2020 were identified. 94 (15.0%) patients had a history of cancer. 226 age- and sexmatched patients without cancer were selected randomly for comparison with the cancer cohort
The median time from COVID-19 diagnosis to death in the cancer cohort was similar to the non-cancer cohort (8 days (IQR 4–13) vs 7 days (IQR 4– 15), p = 0.64)
Summary
The Coronavirus disease 2019 (COVID-19) global pandemic caused by the SARS-CoV-2 virus necessitated urgent and pragmatic measures to protect the most vulnerable people in society, including those with cancer. The early narratives that patients with cancer may have poorer outcomes in COVID-19 were shaped predominantly by a small number of North American and Chinese studies comparing patients with cancer to those without cancer These studies reported a high total case fatality rate for patients with cancer hospitalized with COVID19, ranging from 11 to 28% [1,2,3]. Established risk factors for severe COVID-19, such as increasing age and co-morbidity are common in these patients It remains unclear whether cancer contributes an independent risk to mortality in COVID19. The COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19
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