Abstract
Simple SummaryCancer patients may have increased risk from COVID-19 due to impaired fitness and immunosuppression secondary to underlying cancer and the effects of anti-cancer treatments. We previously demonstrated that solid cancer and anti-cancer treatments may be associated with increased death following COVID-19 in an analysis of patients treated in our London hospital during the first wave of the COVID-19 pandemic (March to May 2020). The United Kingdom experienced a second peak of COVID-19 hospitalizations during December 2020 to February 2021. We aimed to compare the outcomes between patients with solid cancer presenting to our hospital during the first and second peaks of the COVID-19 pandemic and to determine if cancer and anti-cancer treatments were still risk factors for death. We found lower overall deaths in our hospital during the second peak. Metastatic cancer and anti-cancer treatments were risk factors for worse outcomes following COVID-19 in patients with cancer.An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.
Highlights
The Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus first peaked during the early months of 2020
These data collection periods corresponded to consecutive waves in COVID-19 infection and hospitalization in the United Kingdom (UK) (Figure 1)
Among patients presenting to University College Hospitals with a confirmed SARS-CoV2 infection, there were 1135 in wave two (1 December 2020 and 8 February 2021, 70-day period) and 626 in wave one (1 March 2020 to 31 May 2020, 92-day period)
Summary
The Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus first peaked during the early months of 2020. America and Asia suggested that a history of cancer was associated with poorer outcomes with reported mortality rates ranging between 13 and 45% [1]. Cancer itself is associated with other SARS-CoV-2-related risk factors such as increasing age and certain co-morbidities. We [2] and others [3,4,5,6] have demonstrated that a history of solid malignancy was a risk factor for mortality when comparing patients with a history of cancer to matched patients without cancer during the first wave of COVID-19. Concerns were raised that the immunosuppressive effects of systemic anti-cancer treatment (SACT) such as cytotoxic chemotherapy could result in poorer outcomes in COVID-19 [7].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
