COVID-19 Risk Factors for Cancer Patients: A First Report with Comparator Data from COVID-19 Negative Cancer Patients.

Beth Russell,Kamarul Zaki,Fidelma Cahill,Alyson Macneil,James Spicer,Mieke Van Hemelrijck,Angela Swampillai,Shahram Kordasti,Rushan Sylva,Deborah Enting,Sheeba Irshad,Richard Sullivan,Anne Rigg,Sophie Papa,Kieran Palmer,David Wrench,Anna Haire,Paul Fields,Harriet Wylie,Paul Ross,Saoirse Dolly,Renee Steel,Danielle Crawley,Isabelle Wilson,Angela Hoyes,Debra H Josephs ,Elinor J Sawyer ,Charlotte Moss ,Belul Shifa ,Maria J Monroy‐Iglesias ,Andrea D’souza ,Ailsa Sita‐Lumsden

doi:10.3390/cancers13102479

Abstract

Simple SummaryThe COVID-19 pandemic has had a detrimental impact on cancer patients globally. Whilst there are several studies looking at the potential risk factors for COVID-19 disease and related death, most of these include non-cancerous patients as the COVID-19 negative comparator group, meaning it is difficult to draw hard conclusions as to the implications for cancer patients. In our study, we utilized data from over 2000 cancer patients from a large tertiary Cancer Centre in London. In summary, our study found that patients who are male, of Black or Asian ethnicity, or with a hematological malignancy are at an increased risk of COVID-19. The use of cancer patients as the COVID-19 negative comparator group is a major advantage to the study as it means we can better understand the true impact of COVID-19 on cancer patients and identify which factors pose the biggest risk to their likelihood of infection with SARS-CoV2.Very few studies investigating COVID-19 in cancer patients have included cancer patients as controls. We aimed to identify factors associated with the risk of testing positive for SARS CoV2 infection in a cohort of cancer patients. We analyzed data from all cancer patients swabbed for COVID-19 between 1st March and 31st July 2020 at Guy’s Cancer Centre. We conducted logistic regression analyses to identify which factors were associated with a positive COVID-19 test. Results: Of the 2152 patients tested for COVID-19, 190 (9%) tested positive. Male sex, black ethnicity, and hematological cancer type were positively associated with risk of COVID-19 (OR = 1.85, 95%CI:1.37–2.51; OR = 1.93, 95%CI:1.31–2.84; OR = 2.29, 95%CI:1.45–3.62, respectively) as compared to females, white ethnicity, or solid cancer type, respectively. Male, Asian ethnicity, and hematological cancer type were associated with an increased risk of severe COVID-19 (OR = 3.12, 95%CI:1.58–6.14; OR = 2.97, 95%CI:1.00–8.93; OR = 2.43, 95%CI:1.00–5.90, respectively). This study is one of the first to compare the risk of COVID-19 incidence and severity in cancer patients when including cancer patients as controls. Results from this study have echoed those of previous reports, that patients who are male, of black or Asian ethnicity, or with a hematological malignancy are at an increased risk of COVID-19.

Highlights

Whilst the COVID-19 research and innovation landscape has led to a plethora of publications in the context of cancer, we still do not have a good understanding of what may make some cancer patients more likely to get infected with SARS-CoV-2
There were slightly more females than males in the cohort (55% vs 45%, respectively); in the COVID-19 positive cohort, there was a higher proportion of males compared to females (59% vs 41%, respectively)
Our results show that cancer patients who are male, of black ethnicity and those with a hematological cancer type were at a significantly increased risk of COVID-19 and mild/moderate disease

Summary

Introduction

Whilst the COVID-19 research and innovation landscape has led to a plethora of publications in the context of cancer, we still do not have a good understanding of what may make some cancer patients more likely to get infected with SARS-CoV-2. Based on 59 studies, including 36,470 patients, male sex and age >70 were found to be consistently associated with a higher risk of COVID-19, severe disease, intensive care unit (ICU) admission, and death [1]. In the context of cancer, several cohort studies presented the clinical and demographic characteristics of cancer patients diagnosed with SARS-CoV-2 infection and/or their association with COVID-19 outcomes [2,3]. The true rate of COVID-19 disease in oncology patients remains unquantified because the denominator is not known, i.e., the actual number of all cancer patients infected with SARS CoV-2 [4]. We have completed this data, which provides us with the unique opportunity to identify which factors are associated with an increased risk of SARS-CoV-2 infection in cancer patients, a question which hitherto has not been investigated due to the lack of data on a comparator, i.e., cancer patients who tested negative for SARS-CoV-2 infection

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