Background Using an updated dataset with more patients and extended follow-up, we further established cancer patient characteristics associated with COVID-19 death. Methods Data on all cancer patients with a positive reverse transcription-polymerase chain reaction swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) at Guy’s Cancer Centre and King’s College Hospital between 29 February and 31 July 2020 was used. Cox proportional hazards regression was performed to identify which factors were associated with COVID-19 mortality. Results Three hundred and six SARS-CoV-2-positive cancer patients were included. Seventy-one had mild/moderate and 29% had severe COVID-19. Seventy-two patients died of COVID-19 (24%), of whom 35 died <7 days. Male sex [hazard ratio (HR): 1.97 (95% confidence interval (CI): 1.15–3.38)], Asian ethnicity [3.42 (1. 59–7.35)], haematological cancer [2.03 (1.16–3.56)] and a cancer diagnosis for >2–5 years [2.81 (1.41–5.59)] or ≥5 years were associated with an increased mortality. Age >60 years and raised C-reactive protein (CRP) were also associated with COVID-19 death. Haematological cancer, a longer-established cancer diagnosis, dyspnoea at diagnosis and raised CRP were indicative of early COVID-19-related death in cancer patients (<7 days from diagnosis). Conclusions Findings further substantiate evidence for increased risk of COVID-19 mortality for male and Asian cancer patients, and those with haematological malignancies or a cancer diagnosis >2 years. These factors should be accounted for when making clinical decisions for cancer patients.

Very few studies investigating COVID-19 in cancer patients have included cancer patients as controls. We aimed to identify factors associated with the risk of testing positive for SARS CoV2 infection in a cohort of cancer patients. We analyzed data from all cancer patients swabbed for COVID-19 between 1st March and 31st July 2020 at Guy’s Cancer Centre. We conducted logistic regression analyses to identify which factors were associated with a positive COVID-19 test. Results: Of the 2152 patients tested for COVID-19, 190 (9%) tested positive. Male sex, black ethnicity, and hematological cancer type were positively associated with risk of COVID-19 (OR = 1.85, 95%CI:1.37–2.51; OR = 1.93, 95%CI:1.31–2.84; OR = 2.29, 95%CI:1.45–3.62, respectively) as compared to females, white ethnicity, or solid cancer type, respectively. Male, Asian ethnicity, and hematological cancer type were associated with an increased risk of severe COVID-19 (OR = 3.12, 95%CI:1.58–6.14; OR = 2.97, 95%CI:1.00–8.93; OR = 2.43, 95%CI:1.00–5.90, respectively). This study is one of the first to compare the risk of COVID-19 incidence and severity in cancer patients when including cancer patients as controls. Results from this study have echoed those of previous reports, that patients who are male, of black or Asian ethnicity, or with a hematological malignancy are at an increased risk of COVID-19.

Background: The Coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact on the treatment of cancer patients. Understanding the clinical course, potential risk factors for severe infection and excess mortality, is essential to improve patient outcomes. We previously presented preliminary results from 156 SARS-CoV-2 positive cancer patients from Guy’s Cancer Center, which suggested that increased COVID-19 mortality was associated with a diagnosis of cancer for over 2 years, Asian ethnicity and being on palliative treatment. Herein, we present an updated analysis using data from Guy’s Cancer Centre and a partner Hospital Trust (King’s College Hospital), with an increased number of patients and an extended follow up. Methods: We performed an analysis of all cancer patients who had a positive RT-PCR nasal/throat swab for SARS-CoV-2 infection at our Centers between 29th February and 31st July 2020. Associations between patients’ demographics, clinical characteristics, and laboratory investigations with COVID-19 severity and mortality, were assessed using Logistic regression and Cox proportional hazards models. Results: 306 SARS-CoV-2 positive cancer patients were included in the analysis with a median follow up of 134 days (IQR 32-156). 184 (60%) were male and 217 (71%) were aged over 60 (mean age: 66). The most common malignancies were haematological (38%) and urological-gynaecological (20%). 218 (71%) had mild/moderate COVID-19 and 88 (29%) had severe disease. The overall COVID-related mortality rate was 24%; 19% in solid and 32% in haematological cancers. Male sex [OR: 1.84 (95%CI:1.08-3.13)], Asian ethnicity [3.86 (1.20-12.36)], haematological cancer type [2.16 (1.18-3.95)], being diagnosed with cancer for 2-5 years [3.74 (1.80-7.78)] or ≥5 years [3.06 (1.50-6.26)] and a ferritin &gt; 1964 mcg/l [54.92 (5.90-511.33)] were all associated with a risk of developing severe COVID-19 disease. Similarly, male sex [HR:1.97 (95%CI:1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer type [2.03 (1.16-3.56)] as well as a cancer diagnosis for &gt;2-5 years [2.81 (1.41-5.59)] or ≥5 years [2.13 (1.06-4.27)] and a ferritin &gt; 1964 mcg/l [16.11 (3.81-68.17)] were associated with an increased risk of death from COVID-19. Age &gt;60 [2.14 (1.15-3.98)] and a raised CRP [4.10 (1.66-10.10)] were also associated with COVID-19 death. An inverse relationship was observed between a raised albumin and COVID-19 related death [0.12 (0.03-0.51)]. Performance status and treatment paradigm were not associated with COVID-19 severity or mortality. Conclusions: This study further substantiates the evidence for an increased risk of severe COVID-19 infection and mortality for male and Asian patients with cancer, and those with haematological malignancies or with a diagnosis of cancer for over 2 years. These risk factors should be taken into account when making clinical decisions for cancer patients during the pandemic. Citation Format: Kieran Palmer, Rushan Sylva, Beth Russell, Charlotte Moss, Vallari Shah, Thinzar Ko Ko, Gincy George, Shahram Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Kamarul Zaki, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Angela Swampillai, Elinor Sawyer, Mary Lei, Andrea D’Souza, Simon Gomberg, Paul Fields, David Wrench, Richard Sullivan, Anne Rigg, Austin Kulasekararaj, Mieke Van Hemelrijck, Saoirse Dolly. Factors affecting COVID-19 outcomes in cancer patients from Guy’s Cancer Center and King's College Hospital [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P44.

e18797 Background: The COVID-19 pandemic was declared in the UK in February 2020, impacting significantly on healthcare. Delivery of systemic anti-cancer treatment (SACT) rapidly adapted to minimize patient exposure to SARS-CoV-2. The risks of SACT and concomitant COVID-19 infection are unknown. Here we report the patient/tumour characteristics of pts with any GYN cancer undergoing SACT during the first wave to understand risks of SACT and establish clinical guidelines for safe management in the ongoing SARS-CoV2 pandemic. Methods: Demographic and clinical characteristics of GYN cancer pts receiving at least one SACT between 1st March- 31st May 2020 (first wave COVID-19) were compared to the same three month timeframe in 2019. SARS-CoV2 infection was defined as a positive RT-PCR test for COVID-19. Pts with symptoms or radiological changes alone were not considered SARS-COV2 positive. As part of the Guy’s Cancer Cohort we collected information on age, ethnicity, performance status (PS), cancer type, stage (Stg), treatment (SACT, surgery, radiotherapy) and COVID-19 infection. Results: There were no COVID-19 related deaths. 1 pt (0.5%) had SACT delay due to confirmed SARS-CoV-2 infection. Overall mortality at 6 months in each timeframe was 6.9% in 2020 and 8.1% in 2019. In the comparative 3-month intervals, similar numbers of GYN cancer pts received SACT in 2020 compared to 2019: 170 patients (126 ovarian; 44 non-ovarian) in 2020, 184 (131 ovarian; 53 non-ovarian) in 2019. Median age was 61y in both groups and BAME ethnicity was balanced. In 2020, more pts had Stg III/IV disease (93%) than 2019 (84%) and fewer had Stg I/II disease (7%) compared to 2019 (16%). PS was: 0-1 in 92% of patients in 2020 vs 85% in 2019. The average number of cycles of SACT delivered in each time frame was 3. In 2020 9% received neoadjuvant SACT of which 69% proceeded to planned surgery and 31% were deemed unfit. Comparatively, in 2019 7% received neoadjuvant SACT of whom 75% proceeded to surgery and 25% were deemed unfit. In 2020, 3 pt received chemoradiation compared to 8 in 2019. 40 of 170 pts (24%) had 1-5 week treatment delays in 2020 due to any aetiology with. In 2019 there were treatment delays in 63 of 184 pts (34%). The use of GCSF in support of all SACT regimens was 52% in 2020 vs 11% in 2019. Conclusions: There was no increase in mortality associated with SACT during the first wave of the COVID-19 pandemic in GYN cancer pts. 0.5% of pts had confirmed SARS-COV2 infection. We were able to maintain full SACT delivery for all GYN cancer pts with average cycle number unchanged between 2019 and 2020. There was no significant reduction in surgical debulking rates. In contrast, there was a reduction in GYN cancer pts receiving chemoradiation. More pts presented with Stg III/IV disease in 2020. Increased use of GSCF may have contributed to the reduced chemotherapy delays in 2020. Further research will explore the impact of vaccination.

Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age &gt;60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for &gt;2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy’s Cancer Centre and one of its partner trusts (King’s College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death &lt;7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer &gt;24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death &lt;7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and &gt;5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death &lt;7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients. Citation Format: Maria J. Monroy-Iglesias, Beth Russell, Charlotte Moss, Gincy George, Kieran Palmer, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Sharam Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Rushan Sylva, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmistha Ghosh, Claire Harrison, Angela Swampillai, Elinor Sawyer, Andrea D'Souza, Simon Gomberg, Paul Fields, David Wrench, Kavita Raj, Mary Gleeson, Kate Bailey, Richard Dillon, Matthew Streetly, Austin Kulasekararaj, Thinzar Ko Ko, Vallari Shah, Anne Rigg, Richard Sullivan, Mieke Van Hemelrijck, Saoirse Dolly. Clinical and demographic characteristics associated with shorter time to COVID-19 death [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-03.