COVID-19 in cancer patients on systemic anti-cancer therapies: outcomes from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study

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). This study 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: Data was collected from 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.

Results: A total of 2871 patients receiving SACT from 2 March to 31 May 2020 were analysed; 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.) odds ratio (OR) 9.84; 95% confidence interval (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 (adj. 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.

Conclusion: 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.

Keywords: COVID-19; SACT; SARS-CoV-2; cancer; chemotherapy; coronavirus; hormone therapy; immunotherapy; novel coronavirus; oncology; systemic anti-cancer treatment; targeted treatment; tumour.

Figure 1.

An illustration depicting the current RT-PCR based method of detecting patient infection with SARS-CoV-2 to confirm a diagnosis of COVID-19. RT-PCR, reverse transcription-polymerase chain reaction.

Figure 2.

A CONSORT diagram illustrating the study design and the overall patient numbers. SACT, systemic anti-cancer treatments.

Figure 3.

Univariate regression analysis and OR of developing COVID-19, with 95% CIs. Red bars indicate criteria for statistical significance were met (p < 0.05). All models include variables age (continuous), gender (male/female), CVD (yes/no), HTN (yes/no), COPD (yes/no) and diabetes (yes/no) by default. CI, confidence interval; CNS, central nervous system; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; HTN, hypertension; OR, odds ratio.

Figure 4.

Univariate regression analysis and OR of death from COVID-19, with 95% CIs. Red bars indicate criteria for statistical significance were met (p < 0.05). The corrected risk of death included include variables age (continuous), gender (male/female), CVD (yes/no), HTN (yes/no), COPD (yes/no) and diabetes (yes/no). CI, confidence interval; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; HTN, hypertension; OR, odds ratio.

Figure 5.

(A–C) HR-CT chest of a 48-year-old man with (DLBCL), prior to infection with COVID-19. (D–F) HR-CT of the same DLBCL patient at the time of diagnosis with COVID-19. Images show bilateral multiple patchy areas of ground-glass changes involving all the lobes, mainly peripheral. Systemic anti-cancer treatment at time of infection was with rituximab and polatuzumab (bendamustine had been held in light of the COVID-19 pandemic). DLBCL, diffuse large B-cell lymphoma; HR-CT, High resolution computed tomography.