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. 2022 Feb 1;5(2):e220130.
doi: 10.1001/jamanetworkopen.2022.0130.

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Csilla Várnai  1   2   3 , Claire Palles  2 , Roland Arnold  2 , Helen M Curley  2 , Karin Purshouse  4 , Vinton W T Cheng  5 , Stephen Booth  6 , Naomi A Campton  7 , Graham P Collins  6 , Daniel J Hughes  8 , Austin G Kulasekararaj  9 , Alvin J X Lee  10 , Anna C Olsson-Brown  11   12 , Archana Sharma-Oates  13 , Mieke Van Hemelrijck  14 , Lennard Y W Lee  2   15 , Rachel Kerr  15 , Gary Middleton  3   16   17 , Jean-Baptiste Cazier  1   2   3   17 ; UKCCMP Team
Collaborators, Affiliations

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Csilla Várnai et al. JAMA Netw Open. .

Erratum in

  • Error in Supplement 2.
    [No authors listed] [No authors listed] JAMA Netw Open. 2022 Apr 1;5(4):e2210276. doi: 10.1001/jamanetworkopen.2022.10276. JAMA Netw Open. 2022. PMID: 35394519 Free PMC article. No abstract available.

Abstract

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality.

Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality.

Design, setting, and participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis.

Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated.

Main outcomes and measures: The primary end point was all-cause mortality within the primary hospitalization.

Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19-related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86).

Conclusions and relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Palles reported receiving grants from Blood Cancer UK and Bowel Cancer UK during the conduct of the study. Dr Arnold reported receiving grants from Blood Cancer UK during the conduct of the study. Dr Curley reported receiving grants from Blood Cancer UK during the conduct of the study. Dr Purshouse reported receiving a fellowship from the Wellcome Trust during the conduct of the study. Dr Hughes reported received research funding from Nanomab Technology, personal fees from Pfizer, and speakers’ fees from Novartis outside the submitted work. Dr Olsson-Brown reported receiving grant support from Roche, Bristol Myers Squibb, Eli Lilly and Co, Novartis, and UCB Pharma and receiving personal fees from Roche, Merck Sharpe and Dohme, Eisai, and Bristol Myers Squibb outside the submitted work. Prof Middleton reported receiving personal fees from Bristol Myers Squibb, Servier, Roche, Merck Sharpe and Dohme, AstraZeneca, Pfizer, and D2G outside the submitted work. Prof Cazier reported grants from Blood Cancer UK during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association Between Anticancer Treatment Within 4 Weeks of COVID-19 Diagnosis and All-Cause Mortality
Multivariate analyses, adjusted for age, sex, and comorbidities, are presented, and nominal P values are reported. OR indicates odds ratio.
Figure 2.
Figure 2.. All-Cause Case Mortality Rate After Presentation With COVID-19, by Cancer Type, Age, and Sex Sorted by Decreasing Overall Rate
Cells are colored by case mortality rate; numbers in cells are the number of patients with the displayed sex, age, and cancer type combination, with values for cells including fewer than 5 participants suppressed to protect patient privacy. Empty cells indicate no patients. CLL indicates chronic lymphocytic leukemia; CML, chronic myeloid leukemia; CNS, central nervous system; and MDS, myelodysplastic syndrome.
See this image and copyright information in PMC

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