Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital

Abstract

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.

The impact of cancer metastases on COVID‐19 outcomes: A COVID‐19 and Cancer Consortium registry‐based retrospective cohort study

“…USA West 122 ( 15) 97 ( 14) 90 ( 15) 92 ( 16) 30 (11) Outside USA 79 ( 9) 79 ( 11) 49 ( 8) 56 ( 10) 31 (11) Median BMI, kg/m…”

“…[8][9][10] Few studies have specifically evaluated the impact of site of metastatic cancer on COVID-19 outcomes. 11 We leveraged data from the COVID-19 and Cancer Consortium (CCC19) registry to investigate the association between sites of cancer metastasis on COVID-19 outcomes.…”

“…Patients with metastatic cancer are at risk of poor outcomes during COVID‐19 infection because of the virus’s effect on the immune system’s ability to fight infections and its ability to create a microenvironment conducive to tumor cell proliferation 8–10 . Few studies have specifically evaluated the impact of site of metastatic cancer on COVID‐19 outcomes 11 . We leveraged data from the COVID‐19 and Cancer Consortium (CCC19) registry to investigate the association between sites of cancer metastasis on COVID‐19 outcomes.…”