COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study - 29/09/20

Doi : 10.1016/S1470-2045(20)30442-3

Lennard Y W Lee, DPhil ^a,^j,^m,^{*
Joint first authors}, Jean-Baptiste Cazier, ProfPhD ^a,^b,^{*
Joint first authors}, Thomas Starkey, MSci ^a,^{*
Joint first authors}, Sarah E W Briggs, MRCP ^g, Roland Arnold, PhD ^a, Vartika Bisht, MSc ^b, Stephen Booth, FRCPath ^h, Naomi A Campton, PhD ^k, Vinton W T Cheng, DPhil ^l, Graham Collins, DPhil ^h, Helen M Curley, PhD ^a, Philip Earwaker, DPhil ^m, Matthew W Fittall, PhD ⁿ, Spyridon Gennatas, PhD ⁿ, Anshita Goel, PhD ^a, Simon Hartley, PhD ^b,^c, Daniel J Hughes, MRCP ^o, David Kerr, FMedSci ⁱ, Alvin J X Lee, PhD ^p, Rebecca J Lee, PhD ^r,^s, Siow Ming Lee, ProfFRCP ^q, Hayley Mckenzie, MBBS ^t, Chris P Middleton, PhD ^a,^b, Nirupa Murugaesu, PhD ^u, Tom Newsom-Davis, FRCP ^v, Anna C Olsson-Brown, MBChB ^w, Claire Palles, PhD ^a, Thomas Powles, ProfMD ^x, Emily A Protheroe ^d, Karin Purshouse, MBBS ^y, Archana Sharma-Oates, PhD ^e, Shivan Sivakumar, PhD ^j, Ashley J Smith, MSc ^z, Oliver Topping, MBChB ^m, Chris D Turnbull, DPhil ^g, Csilla Várnai, PhD ^a,^b, Adam D M Briggs, DPhil ^aa, Gary Middleton, ProfFRCP ^f,^m,^{^{†
Joint senior authors},}⁎ , Rachel Kerr, FRCP ^j,^{^{†
Joint senior authors}}
on behalf of the
UK Coronavirus Cancer Monitoring Project Team
Abigail Gault, Michael Agnieszka, Ahmed Bedair, Aisha Ghaus, Akinfemi Akingboye, Alec Maynard, Alexander Pawsey, Ali Abdulnabi Suwaidan, Alicia Okines, Alison Massey, Amy Kwan, Ana Ferreira, Angelos Angelakas, Anjui Wu, Ann Tivey, Anne Armstrong, Annet Madhan, Annet Pillai, Ashley Poon-King, Bartlomiej Kurec, Caroline Usborne, Caroline Dobeson, Christina Thirlwell, Christian Mitchell, Christopher Sng, Christopher Scrase, Christopher Jingree, Clair Brunner, Claire Fuller, Clare Griffin, Craig Barrington, Daniel Muller, Diego Ottaviani, Duncan Gilbert, Eliana Tacconi, Ellen Copson, Emily Renninson, Emma Cattell, Emma Burke, Fiona Smith, Francesca Holt, Gehan Soosaipillai, Hayley Boyce, Heather Shaw, Helen Hollis, Helen Bowyer, Iris Anil, Jack Illingworth, Jack Gibson, Jaishree Bhosle, James Best, Jane Barrett, Jillian Noble, Joseph Sacco, Joseph Chacko, Julia Chackathayil, Kathryn Banfill, Laura Feeney, Laura Horsley, Lauren Cammaert, Leena Mukherjee, Leonie Eastlake, Louise Devereaux, Lucinda Melcher, Lucy Cook, Mabel Teng, Madeleine Hewish, Madhumita Bhattacharyya, Mahbuba Choudhury, Mark Baxter, Martin Scott-Brown, Matthew Fittall, Michael Tilby, Michael Rowe, Michael Agnieszka, Mohammed Alihilali, Myria Galazi, Nadia Yousaf, Neha Chopra, Nicola Cox, Olivia Chan, Omar Sheikh, Paul Ramage, Paul Greaves, Pauline Leonard, Peter S Hall, Piangfan Naksukpaiboon, Pippa Corrie, Rahul Peck, Rachel Sharkey, Rachel Bolton, Rebecca Sargent, Rema Jyothirmayi, Robert Goldstein, Roderick Oakes, Rohan Shotton, Ruhi Kanani, Ruth Board, Ruth Pettengell, Ryan Claydon, Sam Moody, Samah Massalha, Sangary Kathirgamakarthigeyan, Saoirse Dolly, Sarah Derby, Sarah Lowndes, Sarah Benafif, Sarah Eeckelaers, Sarah Kingdon, Sarah Ayers, Sean Brown, Shawn Ellis, Shefali Parikh, Sian Pugh, Simon Shamas, Simon Wyatt, Simon Grumett, Sin Lau, Yien Ning Sophia Wong, Sophie McGrath, Stephanie Cornthwaite, Stephen Hibbs, Tania Tillet, Taslima Rabbi, Tim Robinson, Tom Roques, Vasileios Angelis, Victoria Woodcock, Victoria Brown, YingYing Peng, Yvette Drew, Zoe Hudson

^a Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK

^b Centre for Computational Biology, University of Birmingham, Birmingham, UK

^c Advanced Research Computing, University of Birmingham, Birmingham, UK

^d University of Birmingham Medical School, University of Birmingham, Birmingham, UK

^e Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

^f Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK

^g Nuffield Department of Medicine, University of Oxford, Oxford, UK

^h Department of Haematology, University of Oxford, Oxford, UK

ⁱ Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK

^j Department of Oncology, University of Oxford, Oxford, UK

^k Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK

^l Leeds Institute of Medical Research, University of Leeds, Leeds, UK

^m University Hospitals Birmingham, Birmingham, UK

ⁿ The Royal Marsden Hospital NHS Foundation Trust, London, UK

^o Department of Cancer Imaging, King’s College London, London, UK

^p UCL Cancer Institute, University College London, London, UK

^q University College London, London, UK

^r The University of Manchester, Manchester, UK

^s The Christie NHS Foundation Trust, Manchester, UK

^t University Hospital Southampton, UK

^u St George’s University Hospitals NHS Foundation Trust, London, UK

^v Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

^w The Clatterbridge Cancer Centre, Birkenhead, UK

^x Bart’s Cancer Institute, London, UK

^y Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK

^z Consultancy Support, Oxford, UK

^aa Warwick Medical School, University of Warwick, Coventry, UK

^* Correspondence to: Prof Gary Middleton, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK Institute of Immunology and Immunotherapy University of Birmingham Birmingham B15 2TT UK

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Summary

Background

Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK.

Methods

We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case–fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models.

Findings

319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case–fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40–49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15–2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case–fatality rate (2·25, 1·13–4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09–4·08; p=0·028).

Interpretation

Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk–benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies.

Funding

University of Birmingham and University of Oxford.

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Vol 21 - N° 10

P. 1309-1316 - octobre 2020 Retour au numéro

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COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study - 29/09/20

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