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. 2020 Nov 20:10:595804.
doi: 10.3389/fonc.2020.595804. eCollection 2020.

Cancer History and Systemic Anti-Cancer Therapy Independently Predict COVID-19 Mortality: A UK Tertiary Hospital Experience

Christopher C T Sng  1 , Yien Ning Sophia Wong  1   2 , Anjui Wu  1 , Diego Ottaviani  1 , Neha Chopra  1 , Myria Galazi  1 , Sarah Benafif  1 , Gehan Soosaipillai  1 , Rebecca Roylance  1   3 , Alvin J X Lee  1   2 , Heather Shaw  1
Affiliations

Cancer History and Systemic Anti-Cancer Therapy Independently Predict COVID-19 Mortality: A UK Tertiary Hospital Experience

Christopher C T Sng et al. Front Oncol. .

Abstract

Background: The COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond. It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19.

Methods: We included patients at a London tertiary hospital with laboratory confirmed SARS-CoV-2 infection. All patients with a history of solid cancer were included. Age- and sex-matched patients without cancer were randomly selected. Patients with hematological malignancies were excluded.

Results: We identified 94 patients with cancer, matched to 226 patients without cancer. After adjusting for age, ethnicity, and co-morbidities, patients with cancer had increased mortality following COVID-19 (HR 1.57, 95% CI:1.04-2.4, p = 0.03). Increasing age (HR 1.49 every 10 years, 95% CI:1.25-1.8, p < 0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73-4.9, p < 0.001), and cerebrovascular disease (HR 1.93, 95% CI:1.18-3.2, p = 0.008) also predicted mortality. Within the cancer cohort, systemic anti-cancer therapy (SACT) within 60 days of COVID-19 diagnosis was an independent risk factor for mortality (HR 2.30, 95% CI: 1.16-4.6, p = 0.02).

Conclusions: Along with known risk factors, cancer and SACT confer an independent risk for mortality following COVID-19. Further studies are needed to understand the socio-economic influences and pathophysiology of these associations.

Keywords: COVID-19; SARS-CoV-2 infection; co-morbidity; risk factors; solid cancers; systemic anti-cancer therapy.

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Figures

Figure 1
Figure 1
Blood investigations for patients with cancer at presentation with SARS-CoV-2 infection. Dashed lines represent the median and dotted lines represent the IQR. *p < 0.05; **p < 0.01; ***p < 0.001; CRP, C-reactive protein; ALT, alanine transaminase; LDH, lactate dehydrogenase.
Figure 2
Figure 2
Risk factors for COVID-19 mortality in combined cancer and non-cancer cohorts. (A) Forest plot showing the hazard ratios from univariate analysis of risk factors associated with mortality in COVID-19. Horizontal bars indicate 95% CI. HR, hazard ratio. (B) Kaplan–Meier plot of survival analysis by age. (C) Multivariate analysis of risk factors associated with mortality following COVID-19.
Figure 3
Figure 3
Assessing recent systemic anti-cancer therapy (SACT) as a predictor of mortality following COVID-19 (A) Adjusted survival curves of patients on systemic anti-cancer therapy with COVID-19. (B) Multivariate survival analysis of pre-morbid risk factors in patients with cancer and COVID-19.
See this image and copyright information in PMC

References

    1. Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discovery (2020) 10(6):783–91. 10.1158/2159-8290.CD-20-0422 - DOI - PMC - PubMed
    1. Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, et al. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discovery (2020) 10(7):935–41. 10.1158/2159-8290.CD-20-0516 - DOI - PMC - PubMed
    1. Tian J, Yuan X, Xiao J, Zhong Q, Yang C, Liu B, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol (2020) 21(7):893–903. 10.1016/S1470-2045(20)30309-0 - DOI - PMC - PubMed
    1. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet (2020) 395:1907–18. 10.1016/S0140-6736(20)31187-9 - DOI - PMC - PubMed
    1. Public Health England Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19, in: GOVUK (2020). Available at: https://www.gov.uk/government/publications/guidance-on-shielding-and-pro... (Accessed July 5, 2020).