A population-scale temporal case-control evaluation of COVID-19 disease phenotype and related outcome rates in patients with cancer in England (UKCCP)

Abstract

Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.

Figure 1

Temporal trends of case-outcome rates between patients with cancer and the non-cancer population in England between November 2020 and August 2022. Case-outcome rates (%) with 95% confidence intervals are shown at 2-month intervals for COVID-19 hospital assessment (A), inpatient hospitalisation (B), intensive care admission (C) and mortality (D).

Figure 2

Relative risk of severe clinical outcomes in subgroups of patients with cancer compared to the non-cancer population following a COVID-19 infection between January 2022 and August 2022. Multivariable logistic regression models adjusting for age, sex, ethnicity and deprivation show the relative risk of COVID-19 hospital assessment (green), inpatient hospitalisation (blue), intensive care admission (orange) and mortality (red). Odds ratios are used to approximate relative risk with 95% confidence intervals. Corresponding ICD-10 codes for specific primary tumour subtypes are listed in brackets.

Figure 3

Case-outcome rates of solid and haematological cancer subtypes by age group and sex (female or male) following a COVID-19 infection in 2022. Case-outcome rates for COVID-19 hospital assessment, inpatient hospitalisation, intensive care admission and mortality are shown for each cancer subtype and are colour coded according to the scales below each heatmap. Grey boxes denote < 10 SARS-CoV-2 tests within a subgroup. White boxes denote < 10 SARS-CoV-2 tests within sex-specific cancer subtypes (female gynaecological, male urological, prostate cancers). Corresponding ICD-10 codes for specific primary tumour subtypes are listed in brackets.