As reported by Lee et al in The Lancet, a prospective cohort study from the United Kingdom performed by the UK Coronavirus Cancer Monitoring Project (UKCCMP) has found that increased risk of COVID-19 mortality in patients with cancer is associated with such factors as age, sex, and comorbidities, but not recent use vs no recent use of cancer chemotherapy or other cancer treatments.
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Study Details
The UKCCMP was launched on March 18, 2020. All patients with cancer presenting to 55 cancer centers in the UK national network from March 18 to April 26, 2020, with COVID-19 were eligible for enrollment into the UKCCMP. To be included in this analysis, patients had to have laboratory-confirmed, symptomatic COVID-19 disease.
Key Findings
A total of 800 patients were included in the study. Of these, 412 (52%) had a mild COVID-19 disease course and 226 (28%) patients died.
On univariate analysis, risk of death from COVID-19 was significantly associated with:
- Increased age (odds ratio [OR] = 9.42, P < .0001; median age of nonsurvivors vs survivors = 73.0 vs 66.0 years)
- Male sex (OR = 1.67, P = .003)
- Presence of hypertension (OR = 1.95, P < .001)
- Presence of cardiovascular disease (OR = 2.32, P < .001).
No significant association was observed for cancer types, stages, or treatments within 4 weeks of COVID-19 diagnosis.
Cancer treatments received by patients within 4 weeks of COVID-19 diagnosis included chemotherapy in 35% of patients, radiotherapy in 10%, targeted treatment in 9%, hormone therapy in 8%, and immunotherapy in 6%.
On multivariate analysis adjusting for age, sex, and comorbidities, receipt vs no receipt of chemotherapy in the past 4 weeks had no significant effect on COVID-19 mortality (OR = 1.18, P = .380). No significant effect was observed for radiotherapy (OR = 0.65, P = .159), targeted therapy (OR = 0.83, P = .559), hormone therapy (OR = 0.90, P = .744), or immunotherapy (OR = 0.59, P = .177).
In further multivariate analysis (adjusted for age, sex, and comorbidities) including patients who had received chemotherapy within 4 weeks of diagnosis, a significantly reduced risk of death was associated with nonpalliative vs palliative chemotherapy (16% vs 35%; OR = 0.40, P = .040). No significant effect was observed for palliative first-line chemotherapy vs other-line (OR = 0.84, P = .690), palliative chemotherapy vs no chemotherapy (OR = 1.48, P = .102), or palliative chemotherapy vs no cancer treatment (OR = 1.05, P = .854).
The investigators concluded, “Mortality from COVID-19 in patients [with cancer] appears to be principally driven by age, [sex], and comorbidities. We are not able to identify evidence that … patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.”
Lennard Y. W. Lee, DPhil, of the Institute of Cancer and Genomic Sciences, University of Birmingham, is the corresponding author for The Lancet article.
Disclosure: The study was funded by the University of Birmingham and University of Oxford. For full disclosures of the study authors, visit thelancet.com.
