COVID-19 in Cancer Patients on Systemic Anti-Cancer Therapies – Outcomes from CAPITOL (COVID-19 Cancer PatIenTOutcomes in North London)

Abstract

Background: Patients with cancer are hypothesised to be at increased risk of contracting COVID-19, leading to changes in treatment pathways in those treated with systemic anti-cancer treatments (SACT). We investigated the outcomes of patients receiving SACT to assess whether they were at greater risk of contracting COVID-19 or having more severe outcomes. Methods: We collected data on all patients receiving SACT in two cancer centres as part of CAPITOL (COVID-19 CAncer PatIenT Outcomes in North London). The primary outcome was the effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT. We used univariable and multivariable models to analyse outcomes, adjusting for age, gender and comorbidities. Findings: We analysed 2871 patients receiving SACT from 2nd March to 31st May 2020; 68 (2.4%) were diagnosed with COVID-19. Cancer patients receiving SACT were more likely to die if they contracted COVID-19 than those who did not (adjusted (adj.) OR 9·84; 95% CI 5·73 – 16·9). Receiving chemotherapy increased the risk of developing COVID-19 (adj. OR 2·99; 95% CI = 1·72 - 5·21), with high dose chemotherapy significantly increasing risk (adj. OR 2·36, 95% CI 1·35 – 6·48), as did the presence of comorbidities (adjusted OR 2·29; 95% CI 1·19 - 4·38), and having a respiratory or intrathoracic neoplasm (adj. OR 2·12; 95% CI 1·04 - 4·36). Receiving targeted treatment had a protective effect (adj. OR 0·53; 95% CI 0·30 – 0·95). Treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers had no significant effect on risk. Interpretation: Patients on SACT are more likely to die if they contract COVID-19. Those on chemotherapy, particularly high dose chemotherapy, are more likely to contract COVID-19, while targeted treatment appears to be protective. Funding: None.Declaration of Interests: NJH reports grants from CRUK Clinical Trial Fellowship, outside the submitted work. VEC, WW, TAF, SD, JB KK, DH, KKS, RK, NC, MD, EB, JB, MF and DH have no conflicts of interest to disclose. Ethics Approval Statement: Research and development approval were sought from University College Hospital, which is where the study was primarily conducted, the ethical approval was granted by the ethics committee of University College London Hospital NHSFoundation Trust.