COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

doi:10.1016/S1470-2045(20)30442-3

. 2020 Oct;21(10):1309-1316.

doi: 10.1016/S1470-2045(20)30442-3. Epub 2020 Aug 24.

COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

Lennard Y W Lee¹, Jean-Baptiste Cazier², Thomas Starkey³, Sarah E W Briggs⁴, Roland Arnold³, Vartika Bisht⁵, Stephen Booth⁶, Naomi A Campton⁷, Vinton W T Cheng⁸, Graham Collins⁶, Helen M Curley³, Philip Earwaker⁹, Matthew W Fittall¹⁰, Spyridon Gennatas¹⁰, Anshita Goel³, Simon Hartley¹¹, Daniel J Hughes¹², David Kerr¹³, Alvin J X Lee¹⁴, Rebecca J Lee¹⁵, Siow Ming Lee¹⁶, Hayley Mckenzie¹⁷, Chris P Middleton², Nirupa Murugaesu¹⁸, Tom Newsom-Davis¹⁹, Anna C Olsson-Brown²⁰, Claire Palles³, Thomas Powles²¹, Emily A Protheroe²², Karin Purshouse²³, Archana Sharma-Oates²⁴, Shivan Sivakumar²⁵, Ashley J Smith²⁶, Oliver Topping⁹, Chris D Turnbull⁴, Csilla Várnai², Adam D M Briggs²⁷, Gary Middleton²⁸, Rachel Kerr²⁵; UK Coronavirus Cancer Monitoring Project Team

Collaborators, Affiliations

Collaborators

UK Coronavirus Cancer Monitoring Project Team:
Abigails Gault, Michael Agnieszka, Ahmed Bedair, Aisha Ghaus, Akinfemi Akingboye, Alec Maynard, Alexander Pawsey, Ali Abdulnabi Suwaidan, Alicia Okines, Alison Massey, Amy Kwan, Ana Ferreira, Angelos Angelakas, Anjui Wu, Ann Tivey, Anne Armstrong, Annet Madhan, Annet Pillai, Ashley Poon-King, Bartlomiej Kurec, Caroline Usborne, Caroline Dobeson, Christina Thirlwell, Christian Mitchell, Christopher Sng, Christopher Scrase, Christopher Jingree, Clair Brunner, Claire Fuller, Clare Griffin, Craig Barrington, Daniel Muller, Diego Ottaviani, Duncan Gilbert, Eliana Tacconi, Ellen Copson, Emily Renninson, Emma Cattell, Emma Burke, Fiona Smith, Francesca Holt, Gehan Soosaipillai, Hayley Boyce, Heather Shaw, Helen Hollis, Helen Bowyer, Iris Anil, Jack Jack Illingworth Gibson, Jaishree Bhosle, James Best, Jane Barrett, Jillian Noble, Joseph Sacco, Joseph Chacko, Julia Chackathayil, Kathryn Banfill, Laura Feeney, Laura Horsley, Lauren Cammaert, Leena Mukherjee, Leonie Eastlake, Louise Devereaux, Lucinda Melcher, Lucy Cook, Mabel Teng, Madeleine Hewish, Madhumita Bhattacharyya, Mahbuba Choudhury, Mark Baxter, Martin Scott-Brown, Matthew Fittall, Michael Tilby, Michael Rowe, Michael Agnieszka, Mohammed Alihilali, Myria Galazi, Nadia Yousaf, Neha Chopra, Nicola Cox, Olivia Chan, Omar Sheikh, Paul Ramage, Paul Greaves, Pauline Leonard, Peter S Hall, Piangfan Naksukpaiboon, Pippa Rahul Corrie Peck, Rachel Sharkey, Rachel Bolton, Rebecca Sargent, Rema Jyothirmayi, Robert Goldstein, Roderick Oakes, Rohan Ruhi Shotton Kanani, Ruth Board, Ruth Pettengell, Ryan Claydon, Sam Moody, Samah Massalha, Sangary Kathirgamakarthigeyan, Saoirse Dolly, Sarah Derby, Sarah Lowndes, Sarah Benafif, Sarah Kingdon, Sarah Ayers, Sean Brown, Shawn Ellis, Shefali Parikh, Sian Pugh, Simon Shamas, Simon Wyatt, Simon Grumett, Sin Lau, Yien Ning Sophia Wong, Sophie McGrath, Stephanie Cornthwaite, Stephanie Eeckelaers, Stephen Hibbs, Tania Tillet, Taslima Rabbi, Tim Robinson, Tom Roques, Vasileios Angelis, Victoria Woodcock, Victoria Brown, YingYing Peng, Yvette Drew, Zoe Hudson

Affiliations

¹ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Oncology, University of Oxford, Oxford, UK; University Hospitals Birmingham, Birmingham, UK.
² Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.
³ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
⁴ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁵ Centre for Computational Biology, University of Birmingham, Birmingham, UK.
⁶ Department of Haematology, University of Oxford, Oxford, UK.
⁷ Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.
⁸ Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
⁹ University Hospitals Birmingham, Birmingham, UK.
¹⁰ The Royal Marsden Hospital NHS Foundation Trust, London, UK.
¹¹ Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK.
¹² Department of Cancer Imaging, King's College London, London, UK.
¹³ Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK.
¹⁴ UCL Cancer Institute, University College London, London, UK.
¹⁵ The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
¹⁶ University College London, London, UK.
¹⁷ University Hospital Southampton, UK.
¹⁸ St George's University Hospitals NHS Foundation Trust, London, UK.
¹⁹ Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
²⁰ The Clatterbridge Cancer Centre, Birkenhead, UK.
²¹ Bart's Cancer Institute, London, UK.
²² University of Birmingham Medical School, University of Birmingham, Birmingham, UK.
²³ Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
²⁴ Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
²⁵ Department of Oncology, University of Oxford, Oxford, UK.
²⁶ Consultancy Support, Oxford, UK.
²⁷ Warwick Medical School, University of Warwick, Coventry, UK.
²⁸ Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK. Electronic address: g.middleton@bham.ac.uk.

PMID: 32853557
PMCID: PMC7444972
DOI: 10.1016/S1470-2045(20)30442-3

COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

Lennard Y W Lee et al. Lancet Oncol. 2020 Oct.

. 2020 Oct;21(10):1309-1316.

doi: 10.1016/S1470-2045(20)30442-3. Epub 2020 Aug 24.

Authors

Collaborators

UK Coronavirus Cancer Monitoring Project Team:
Abigails Gault, Michael Agnieszka, Ahmed Bedair, Aisha Ghaus, Akinfemi Akingboye, Alec Maynard, Alexander Pawsey, Ali Abdulnabi Suwaidan, Alicia Okines, Alison Massey, Amy Kwan, Ana Ferreira, Angelos Angelakas, Anjui Wu, Ann Tivey, Anne Armstrong, Annet Madhan, Annet Pillai, Ashley Poon-King, Bartlomiej Kurec, Caroline Usborne, Caroline Dobeson, Christina Thirlwell, Christian Mitchell, Christopher Sng, Christopher Scrase, Christopher Jingree, Clair Brunner, Claire Fuller, Clare Griffin, Craig Barrington, Daniel Muller, Diego Ottaviani, Duncan Gilbert, Eliana Tacconi, Ellen Copson, Emily Renninson, Emma Cattell, Emma Burke, Fiona Smith, Francesca Holt, Gehan Soosaipillai, Hayley Boyce, Heather Shaw, Helen Hollis, Helen Bowyer, Iris Anil, Jack Jack Illingworth Gibson, Jaishree Bhosle, James Best, Jane Barrett, Jillian Noble, Joseph Sacco, Joseph Chacko, Julia Chackathayil, Kathryn Banfill, Laura Feeney, Laura Horsley, Lauren Cammaert, Leena Mukherjee, Leonie Eastlake, Louise Devereaux, Lucinda Melcher, Lucy Cook, Mabel Teng, Madeleine Hewish, Madhumita Bhattacharyya, Mahbuba Choudhury, Mark Baxter, Martin Scott-Brown, Matthew Fittall, Michael Tilby, Michael Rowe, Michael Agnieszka, Mohammed Alihilali, Myria Galazi, Nadia Yousaf, Neha Chopra, Nicola Cox, Olivia Chan, Omar Sheikh, Paul Ramage, Paul Greaves, Pauline Leonard, Peter S Hall, Piangfan Naksukpaiboon, Pippa Rahul Corrie Peck, Rachel Sharkey, Rachel Bolton, Rebecca Sargent, Rema Jyothirmayi, Robert Goldstein, Roderick Oakes, Rohan Ruhi Shotton Kanani, Ruth Board, Ruth Pettengell, Ryan Claydon, Sam Moody, Samah Massalha, Sangary Kathirgamakarthigeyan, Saoirse Dolly, Sarah Derby, Sarah Lowndes, Sarah Benafif, Sarah Kingdon, Sarah Ayers, Sean Brown, Shawn Ellis, Shefali Parikh, Sian Pugh, Simon Shamas, Simon Wyatt, Simon Grumett, Sin Lau, Yien Ning Sophia Wong, Sophie McGrath, Stephanie Cornthwaite, Stephanie Eeckelaers, Stephen Hibbs, Tania Tillet, Taslima Rabbi, Tim Robinson, Tom Roques, Vasileios Angelis, Victoria Woodcock, Victoria Brown, YingYing Peng, Yvette Drew, Zoe Hudson

Affiliations

¹ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Oncology, University of Oxford, Oxford, UK; University Hospitals Birmingham, Birmingham, UK.
² Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.
³ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
⁴ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁵ Centre for Computational Biology, University of Birmingham, Birmingham, UK.
⁶ Department of Haematology, University of Oxford, Oxford, UK.
⁷ Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.
⁸ Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
⁹ University Hospitals Birmingham, Birmingham, UK.
¹⁰ The Royal Marsden Hospital NHS Foundation Trust, London, UK.
¹¹ Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK.
¹² Department of Cancer Imaging, King's College London, London, UK.
¹³ Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK.
¹⁴ UCL Cancer Institute, University College London, London, UK.
¹⁵ The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
¹⁶ University College London, London, UK.
¹⁷ University Hospital Southampton, UK.
¹⁸ St George's University Hospitals NHS Foundation Trust, London, UK.
¹⁹ Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
²⁰ The Clatterbridge Cancer Centre, Birkenhead, UK.
²¹ Bart's Cancer Institute, London, UK.
²² University of Birmingham Medical School, University of Birmingham, Birmingham, UK.
²³ Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
²⁴ Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
²⁵ Department of Oncology, University of Oxford, Oxford, UK.
²⁶ Consultancy Support, Oxford, UK.
²⁷ Warwick Medical School, University of Warwick, Coventry, UK.
²⁸ Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK. Electronic address: g.middleton@bham.ac.uk.

PMID: 32853557
PMCID: PMC7444972
DOI: 10.1016/S1470-2045(20)30442-3

Erratum in

Correction to Lancet Oncol 2020; 21: 1309-16.
[No authors listed] [No authors listed] Lancet Oncol. 2020 Oct;21(10):e462. doi: 10.1016/S1470-2045(20)30531-3. Epub 2020 Sep 3. Lancet Oncol. 2020. PMID: 32891190 Free PMC article. No abstract available.

Abstract

Background: Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK.

Methods: We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case-fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models.

Findings: 319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case-fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40-49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15-2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case-fatality rate (2·25, 1·13-4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09-4·08; p=0·028).

Interpretation: Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies.

Funding: University of Birmingham and University of Oxford.

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Figures

**Figure 1**
Age and all-cause case–fatality rate of patients with cancer after presenting with COVID-19 in the UK Coronavirus Cancer Monitoring Project cohort

**Figure 2**
Case–fatality rate after presentation with COVID-19, by tumour subtype, age, and sex Grey boxes represent where the number of cases was less than four, and case–fatality rate was not estimable. White boxes mean not applicable.

See this image and copyright information in PMC

Comment in

COVID-19 in patients with cancer.
Smotherman C, Norez D, Austin-Datta R, Yaghjyan L. Smotherman C, et al. Lancet Oncol. 2020 Dec;21(12):e539. doi: 10.1016/S1470-2045(20)30668-9. Lancet Oncol. 2020. PMID: 33271096 Free PMC article. No abstract available.

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References

1. WHO Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Feb 28, 2020. https://www.who.int/publications-detail/report-of-the-who-china-joint-mi...
1. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335–337. - PMC - PubMed
1. Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020;6:1108–1110. - PMC - PubMed
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1. ESMO Cancer patient management during the COVID-19 pandemic. https://www.esmo.org/guidelines/cancer-patient-management-during-the-cov...

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[1] WHO Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Feb 28, 2020. https://www.who.int/publications-detail/report-of-the-who-china-joint-mi...

[2] WHO Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Feb 28, 2020. https://www.who.int/publications-detail/report-of-the-who-china-joint-mi...

[3] Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335–337. - PMC - PubMed

[4] Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335–337. - PMC - PubMed

[5] Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020;6:1108–1110. - PMC - PubMed

[6] Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020;6:1108–1110. - PMC - PubMed

[7] Miyashita H, Mikami T, Chopra N, et al. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol. 2020 doi: 10.1016/j.annonc.2020.04.006. published online April 21. - DOI - PMC - PubMed

[8] Miyashita H, Mikami T, Chopra N, et al. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol. 2020 doi: 10.1016/j.annonc.2020.04.006. published online April 21. - DOI - PMC - PubMed

[9] ESMO Cancer patient management during the COVID-19 pandemic. https://www.esmo.org/guidelines/cancer-patient-management-during-the-cov...

[10] ESMO Cancer patient management during the COVID-19 pandemic. https://www.esmo.org/guidelines/cancer-patient-management-during-the-cov...

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COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

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COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

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