27 July 2020

Cancer patients who were diagnosed more than 24 months ago have faced increased risk of dying from COVID-19, new research has found.

The study also found that cancer patients of Asian ethnicity or who were receiving palliative treatment for cancer were also at increased risk of death from the virus. It was carried out by researchers at King’s College London, Guy’s and St Thomas’ Foundation Trust and supported by the NIHR Guy’s and St Thomas’ BRC.

The research, published online in the journal Frontiers in Oncology, is the largest single centre analysis of its type on cancer and COVID-19. The observational study tracked the outcomes of 156 cancer patients being treated at Guy’s & St Thomas’ NHS foundation Trust who were diagnosed with COVID-19 between 29th February and 12th May 2020.

Of the total cohort, 82% of patients had mild or moderate COVID-19 infection, with the remaining 18% suffered from severe disease. During a median follow-up period of 37 days, 22% of the cohort died from COVID-19 infection.

The researchers used advanced statistical methods to identify which demographic and clinical characteristics were associated with the severity of COVID-19 or death.

Patients with Asian ethnicity, or those receiving palliative treatment, or who were diagnosed with cancer more than 24 months before the onset of COVID-19 had a higher risk of dying. Patients who presented with dyspnoea or high CRP levels as COVID-19 symptoms also had a higher risk of dying from the virus.

Fever, dyspnoea, and gastro-intestinal symptoms were associated with severe COVID-19 infection rather than mild or moderate disease. However, age, gender, ethnicity or cancer treatment were not associated with severity of infection.

Most of the 156 patients in the cohort were male, and from a lower socio-economic background. Half were white, 22% black and 4% Asian.

The most common tumour types were urological/gynaecological (29%), haematological (18%), and breast cancer (15%). When looking at those with the most severe COVID-19, the largest proportion of cancers were haematological (36%).

Across the whole cohort, 40% of patients had stage IV cancer, and 46% were diagnosed with malignancy in the last 12 months. Nearly three-quarters of the cohort had comorbidities other than cancer, with the most common being hypertension, followed by diabetes, renal impairment and cardiovascular disease. Benign lung conditions were more commonly reported for those who presented with severe COVID-19.

Dr Saoirse Dolly, consultant medical oncologist at Guy’s and St Thomas’ and King’s College Hospital, said: “Over 11 weeks, 1,507 cancer patients were PCR tested for COVID-19. 156 were positive for COVID-19 infection and 18% developed severe infection and 34 patients had sadly died.

“This real-world observation provides valuable insights into our cancer patients during the COVID pandemic. The data needs to be validated in larger series with longer follow-up of patients to provide more definitive guidance on the management of oncology patients through the COVID-19 outbreak.”

Source: Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D’Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Rigg A, Sullivan R, Dolly S, Van Hemelrijck M. (2020) “Factors Affecting COVID-19 Outcomes in Cancer Patients: A First Report From Guy’s Cancer Center in London.” Frontiers in Oncology, doi: 10.3389/fonc.2020.01279


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