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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.
Lancet Oncol. 2020 10; 21(10):1309-1316.LO

Abstract

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.

Authors+Show Affiliations

Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Oncology, University of Oxford, Oxford, UK; University Hospitals Birmingham, Birmingham, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.Nuffield Department of Medicine, University of Oxford, Oxford, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.Centre for Computational Biology, University of Birmingham, Birmingham, UK.Department of Haematology, University of Oxford, Oxford, UK.Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Department of Haematology, University of Oxford, Oxford, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.University Hospitals Birmingham, Birmingham, UK.The Royal Marsden Hospital NHS Foundation Trust, London, UK.The Royal Marsden Hospital NHS Foundation Trust, London, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK.Department of Cancer Imaging, King's College London, London, UK.Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK.UCL Cancer Institute, University College London, London, UK.The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.University College London, London, UK.University Hospital Southampton, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.St George's University Hospitals NHS Foundation Trust, London, UK.Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.The Clatterbridge Cancer Centre, Birkenhead, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.Bart's Cancer Institute, London, UK.University of Birmingham Medical School, University of Birmingham, Birmingham, UK.Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.Department of Oncology, University of Oxford, Oxford, UK.Consultancy Support, Oxford, UK.University Hospitals Birmingham, Birmingham, UK.Nuffield Department of Medicine, University of Oxford, Oxford, UK.Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.Warwick Medical School, University of Warwick, Coventry, UK.Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK. Electronic address: g.middleton@bham.ac.uk.Department of Oncology, University of Oxford, Oxford, UK.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32853557

Citation

Lee, Lennard Y W., et al. "COVID-19 Prevalence and Mortality in Patients With Cancer and the Effect of Primary Tumour Subtype and Patient Demographics: a Prospective Cohort Study." The Lancet. Oncology, vol. 21, no. 10, 2020, pp. 1309-1316.
Lee LYW, Cazier JB, Starkey T, et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol. 2020;21(10):1309-1316.
Lee, L. Y. W., Cazier, J. B., Starkey, T., Briggs, S. E. W., Arnold, R., Bisht, V., Booth, S., Campton, N. A., Cheng, V. W. T., Collins, G., Curley, H. M., Earwaker, P., Fittall, M. W., Gennatas, S., Goel, A., Hartley, S., Hughes, D. J., Kerr, D., Lee, A. J. X., ... Kerr, R. (2020). COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. The Lancet. Oncology, 21(10), 1309-1316. https://doi.org/10.1016/S1470-2045(20)30442-3
Lee LYW, et al. COVID-19 Prevalence and Mortality in Patients With Cancer and the Effect of Primary Tumour Subtype and Patient Demographics: a Prospective Cohort Study. Lancet Oncol. 2020;21(10):1309-1316. PubMed PMID: 32853557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. AU - Lee,Lennard Y W, AU - Cazier,Jean-Baptiste, AU - Starkey,Thomas, AU - Briggs,Sarah E W, AU - Arnold,Roland, AU - Bisht,Vartika, AU - Booth,Stephen, AU - Campton,Naomi A, AU - Cheng,Vinton W T, AU - Collins,Graham, AU - Curley,Helen M, AU - Earwaker,Philip, AU - Fittall,Matthew W, AU - Gennatas,Spyridon, AU - Goel,Anshita, AU - Hartley,Simon, AU - Hughes,Daniel J, AU - Kerr,David, AU - Lee,Alvin J X, AU - Lee,Rebecca J, AU - Lee,Siow Ming, AU - Mckenzie,Hayley, AU - Middleton,Chris P, AU - Murugaesu,Nirupa, AU - Newsom-Davis,Tom, AU - Olsson-Brown,Anna C, AU - Palles,Claire, AU - Powles,Thomas, AU - Protheroe,Emily A, AU - Purshouse,Karin, AU - Sharma-Oates,Archana, AU - Sivakumar,Shivan, AU - Smith,Ashley J, AU - Topping,Oliver, AU - Turnbull,Chris D, AU - Várnai,Csilla, AU - Briggs,Adam D M, AU - Middleton,Gary, AU - Kerr,Rachel, AU - ,, Y1 - 2020/08/24/ PY - 2020/05/27/received PY - 2020/07/15/revised PY - 2020/07/21/accepted PY - 2020/8/28/pubmed PY - 2020/10/21/medline PY - 2020/8/28/entrez SP - 1309 EP - 1316 JF - The Lancet. Oncology JO - Lancet Oncol VL - 21 IS - 10 N2 - 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. SN - 1474-5488 UR - https://www.unboundmedicine.com/medline/citation/32853557/COVID_19_prevalence_and_mortality_in_patients_with_cancer_and_the_effect_of_primary_tumour_subtype_and_patient_demographics:_a_prospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1470-2045(20)30442-3 DB - PRIME DP - Unbound Medicine ER -