Early into the coronavirus disease 2019 (COVID-19) pandemic, some small, inconclusive studies hinted that patients receiving anticancer treatments may be at increased risk of mortality from COVID-19; however, COVID-19-related mortality in patients with cancer may be driven by age, gender, and other comorbidities, not recent anticancer treatment, according to results from a large prospective cohort study published in The Lancet.
The study was a product of the UK Coronavirus Cancer Monitoring Project (UKCCMP). The investigators aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in a large cohort of patients with cancer who were receiving cytotoxic chemotherapy and other anticancer treatments.
All patients with active cancer and presenting to a network of cancer centers in the UK with confirmed COVID-19 (positive viral real-time polymerase chair reaction assay) were eligible for UKCCMP enrollment. Local reporting site personnel were encouraged to enter data on a real-time basis. The primary endpoint was all-cause mortality or discharge from the hospital. Outcomes were monitored from March 18 until April 26, 2020.
The investigators assessed data from 800 patients with cancer and symptomatic COVID-19. COVID-19 disease course was mild for 412 (52%) patients, severe for 187 (23%) patients, and critical for 173 (22%) patients. In total, 226 (28%) patients died.
The risk of death was significantly associated with advanced age (odds ratio [OR], 9.42; P <.0001), male gender (OR, 1.67; P =.003; patient deaths, 33% of all men vs 20% of all women), and having other comorbidities, specifically hypertension (OR, 1.95; P <.001; 41% of those who died vs 27% of survivors; P <.001) and cardiovascular disease (OR, 2.32; 21% of those who died vs 11% of survivors; P <.001).
Overall, 281 of the 800 (35%) patients had received cytotoxic chemotherapy within 4 weeks of testing positive for COVID-19. Those who had recently received chemotherapy treatment had a similar mortality rate compared with those who had not (27% vs 29%, respectively).
In a multivariate analysis adjusting for age, gender, and comorbidities, no significant difference in mortality from COVID-19 disease was found between patients who had received recent chemotherapy treatment compared with those who had not (OR, 1.18; P =.380). Patients who had received immunotherapy, hormonal therapy, targeted therapy, or radiotherapy within the past 4 weeks also had no additional risk of death.
“Our data are strongly indicative that COVID-19 mortality in patients with cancer is principally driven by advancing age and the presence of other non-cancer comorbidities,” wrote the authors. “At a population level, our data do not suggest that chemotherapy or anticancer treatments will necessarily increase the risk of mortality from COVID-19, and gives confidence to oncologists and other clinicians that delivery of effective anticancer regimens should continue during this difficult time.”
Lee LYW, Cazier JB, Starkey T, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study [published online May 28, 2020]. Lancet. doi: 10.1016/S0140-6736(20)31173-9