For patients with cancer, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) susceptibility and coronavirus disease 2019 (COVID-19) phenotype may vary with each tumor subtype, with most notable increases in hospital presentation among patients with hematologic cancers, according to study results published in The Lancet Oncology.
A team of United Kingdom-based investigators conducted a study to determine the risk for COVID-19 depending on tumor subtype and demographics among patients with cancer. The researchers used data from patients who were enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) to compare with a parallel control population of patients with cancer who did not have COVID-19 infection.
The primary outcome measured the effects of subtype, age, and sex on the prevalence of SARS-CoV-2 and case-fatality during hospital admission. Additionally, the researchers also used univariable and multivariable models to measure the association between tumor subtype and patient demographics with the prevalence of COVID-19 and associated mortality.
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A total of 1044 patients (56.9% men; median age, 70 years) from the UKCCMP database were included in the analysis. Participants in this cohort had active cancer with a specified cancer subtype and documented SARS-CoV-2 infection or COVID-19. The median follow-up for either discharge from hospital or death was 6 days.
Compared with patients in the control population (282,878 individuals), patients with cancer and COVID-19 infection were significantly more likely to be men (odds ratio [OR], 1.26; P =.0002), however, age distribution did not vary between both groups.
An increased risk for COVID-19 infection was significantly associated with hematologic cancers, including leukemia (OR, 2.28; 95% CI, 2.21-3.55; P <.0001), myeloma (OR, 2.03; 95% CI, 1.42-2.83; P =.0001), and lymphoma (OR, 1.63; 95% CI, 1.28–2.06; P <.0001). While hematologic cancers were overrepresented in the UKCCMP cohort, lung and prostate cancers were underrepresented. In addition, the trajectory for more severe COVID-19 infection was more significant in hematologic malignancies compared with solid tumors (OR, 1.57; 95% CI, 1.15-2.15; P =.028).
Of the 1044 patients, 319 died (30.6%); 295 of deaths (92.5%) were reportedly due to COVID-19. Increasing patient age was positively correlated with an all-cause case-fatality rate.
Compared with patients who did not receive recent chemotherapy treatment, univariate variable analysis results suggested that recent chemotherapy treatment in patients with hematologic cancers was not significantly associated with an increased risk of death; however, following correction for age and sex, death among this patient group was significantly associated with hospital admission due to COVID-19 (OR, 2.09; 95% CI, 1.09-4.08; P =.028).
“Morbidity and case-fatality rates from COVID-19 in UK patients with cancer who attend hospital are relatively high, particularly in older patients and those with [hematological] malignancies, but not all cancer patients are affected equally,” noted the investigators.
Patients with breast cancer or cancers of the female genital tract were at a much lower risk of contracting or dying from COVID-19; however, multivariable analysis results suggested that the lower risk was due to the patient’s sex rather than their cancer type.
“This important finding could allow clinicians some ability to risk stratify their patients and make informed decisions on appropriate levels of social isolation and shielding. Future work by the UKCCMP, in collaboration with international consortia, will define risk in much greater granularity, including different subtypes of a given [tumor],” the concluded the authors.
Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Reference
Lee LYW, Cazier J-B, Starkey J, et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumor subtype and patient demographics: a prospective cohort study. Lancet Oncol. Published online August 24, 2020. doi:10.10.16/S1470-2045(20)30442-3
