Cancer Patients with COVID Showed No Increase in Overall Mortality

Hospitalized cancer patient having blood pressure checked
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COVID-19 doesn’t seem to put all cancer patients at higher risk of death, according to a large-scale study that involved almost 70 UK hospitals. The researchers found no overall association between risk of death and recent systemic anti-cancer treatments (SACTs), although hematological malignant neoplasms and lung cancer were linked to increased mortality.

This research could have major implications for how cancer patients are managed during the pandemic.

The study looked at 2515 adult patients with cancer and COVID-19 from the UK Coronavirus Cancer Monitoring Project (UKCCMP) — a prospective cohort study involving 69 UK cancer hospitals among adult patients with an active cancer and a clinical diagnosis of COVID-19. The report was published in JAMA Network Open and the lead author was Csilla Várnai of the Centre for Computational Biology, at University of Birmingham.

Early data during the pandemic suggested that cancer patients might have as much as twice the risk of dying from COVID-19 as other patients. Those studies were mainly done in Wuhan.

These researchers aimed to evaluate whether recent SACTs, tumor subtypes, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities are associated with COVID-19 mortality.

Their data do suggest higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome and myeloma or plasmacytoma. Lung cancer was also significantly associated with higher COVID-19–related mortality.

In patients with solid cancer, chronic kidney disease (CKD), coronary vascular disease, COPD, and diabetes were significantly associated with higher mortality. In patients with hematological cancer, only CKD was significantly associated with higher mortality in multivariate analysis adjusting for age and sex. Higher body mass index was also significantly associated with higher mortality, as was smoking history

However, there was no link between higher mortality and receiving chemotherapy in the four weeks before COVID-19 diagnosis was made. Further, there was an association between lower mortality and receiving immunotherapy in the four weeks prior to COVID-19 diagnosis. Overall, 38% of patients in UKCCMP died. But despite 49% of patients presenting with severe or critical COVID-19 illness, only 5% were treated on an intensive care unit.

CVD and CKD were associated with higher mortality across all patients, suggesting that patients with cancer, COVID-19, and known comorbidities represent a particularly vulnerable group. “Cancer teams need to work closely with intensivists and primary and secondary care teams to ensure patients with cancer are offered the appropriate level of treatment,” the authors write.

The authors note that their findings regarding chemotherapy are “at odds” with a recent report from CCC19 (The COVID-19 & Cancer Consortium), which found an association between recent chemotherapy and higher mortality, a finding with potentially significant policy and health care implications. But unlike the UKCCMP cohort that comprises only active cancers, only 61% of the CCC19 cohort had cancer that was present, active, or treated within the past year. The remaining 49% were in remission or had no evidence of disease.

“The outcomes of patients with historical cancers and COVID-19 infection are likely to be very different from those with active cancer,” the authors of this UKCCMP-based data report write.

They added that “This UKCCMP data set provides a unique opportunity to investigate a population within 1 health care system, the NHS. The data will facilitate better risk stratification of patients with cancer who may be exposed to COVID-19 and will permit clinicians to devise individualized care plans with patients that minimize disruption to cancer care.”

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