ABSTRACT
Background: Cancer and systemic anti-cancer treatment (SACT) have been identified as possible risk factors for infection and related severe illness associated with SARS-CoV-2 virus as a consequence of immune suppression. The Scottish COVID CAncer iMmunity Prevalence (SCCAMP) study aimed to characterise the incidence and outcomes of SARS-Cov-2 infection in patients undergoing active anticancer treatment during the COVID-19 pandemic and their antibody response following vaccination. Methods: Eligible patients were those attending secondary care for active anti-cancer treatment for a solid tumour. Blood samples were taken for total SARS-CoV-2 antibody assay (Siemens) at baseline and after 1.5, 3, 6 and 12 months. Data on COVID-19 infection, vaccination, cancer type, treatment and outcome (patient death) was obtained from routine electronic health records. Results: The study recruited 766 eligible participants between 28th May 2020 and 31st October 2021. During the study period there were 174 deaths (22%). The median age was 63 years, and 67% were female. Most received cytotoxic chemotherapy (79%), with the remaining 14% receiving immunotherapy and 7% receiving another form of anti-cancer therapy (radiotherapy, other systemic anti-cancer treatment). 48 (6.3%) tested positive for SARS-CoV-2 by PCR during the study period. The overall infection rate matched that of the local adult general population until May 2021, after which population levels appeared higher than the study population. Antibody testing detected additional evidence of infection prior to vaccination, taking the total number to 58 (7.6%). There was no significant difference in SARS-CoV-2 PCR positive test rates based on type of anti-cancer treatment. Mortality rates were similar between those who died within 90 days of a positive SARS-CoV-2 PCR and those with no positive PCR (10.4% vs 10.6%). Death from all causes was lowest among vaccinated patients, and of the patients who had a positive SARS-CoV-2 PCR at any time, all of those who died during the study period were unvaccinated. Multivariate analysis correcting for age, gender, socioeconomic status, Charlson co-morbidity score and number of previous medications revealed that vaccination was associated with a significantly lower infection rate regardless of treatment with chemotherapy or immunotherapy with hazard ratios of 0.307 (95% CI 0.144-0.6548) or 0.314 (95% CI 0.041-2.367) in vaccinated patients respectively. Where antibody data was available, 96.3% of patients successfully raised SARSCoV-2 antibodies at a time point after vaccination. This was unaffected by treatment type. Conclusions: SCCAMP provides real-world evidence that patients with cancer undergoing SACT have a high antibody response and protection from SARS-CoV-2 infection following COVID-19 vaccination.
ABSTRACT
Introduction: Lung cancer is associated with a lower socio-economic status, major co-morbidities and a poorer performance status. These factors, and the negative association often affiliated with lung cancer, can create barriers to healthcare engagement. Anecdotally patients admitted during the lockdown phase of the COVID-19 pandemic were more unwell and required more intervention than normal. We examined acute admissions during the pandemic to establish the impact of the COVID-19 pandemic on patients with lung cancer. Methods: We identified all patients admitted with suspected or previously diagnosed lung cancer admitted acutely to Edinburgh Cancer Centre between 29th of March and 29th June 2020. In Scotland, lockdown was eased from 29th of May, so we divided our analysis into early lockdown (29th March-April), late lockdown (May) and recovery (June). We gathered patient demographics (age, gender), duration of admission (days), admission route (referral from routine contact with oncology specialist for emergency care, self-presentation to oncology patient helpline, self-presentation to GP or A&E, and planned admission for specialist oncology treatment) and outcomes from the admission, including mortality and palliative care involvement. We compared this with admissions in April 2019. Results: During the three months evaluated, 77 patients were admitted, of whom 46 were male and 31 were female. The mean age of patients was 65.8 (range 42 to 87), with no significant difference between each month assessed. The number of admissions in the 3 assessment periods were 29 (early lockdown), 21 (late lockdown) and 27 (recovery), compared with 10 admissions in April 2019. Patients were admitted for a longer period of time in early lockdown (mean 7.4 days) and late lockdown (mean 7.0 days), but less in the recovery period (mean 2.7 days). There were 3 inpatient deaths in early lockdown, 2 in late lockdown and none during the recovery period, suggesting patients may have been presenting with more advanced acute illness during lockdown. Admission route shifted from being prompted by a routine remote consultation to patient-driven self-presentation as the pandemic progressed. During early and late lockdown, around half of patients were admitted after a scheduled remote consultation (48% (14/29) in early lockdown, 57% (12/21) in late lockdown). In contrast, 19% (5/27) patients were admitted via this route during the recovery period, with 41% (11/27) being admitted via patients self-presenting to the patient helpline and 37% (10/27) self-presenting to A+E/GP. Conclusion: Our data suggests that there were more patients with lung cancer admitted acutely with cancer, non-COVID-19-related illness during the COVID-19 pandemic. The early and late lockdown phase was particularly characterised by a reduction in self-presentation and longer resulting admissions, suggesting patients were admitted with more complex pathology and consequently longer admission from acute illness. Overall, our experience highlights the need to make acute cancer services accessible to patients as the COVID-19 pandemic continues, and that patients with lung cancer may be a particularly vulnerable group. Keywords: COVID-19, Oncology, Admissions
ABSTRACT
Background: The COVID-19 pandemic required a rapid response and need for real-world data in cancer patients. The nationwide, real-time coordinated UKCCMP reporting network provided an immediate solution. Methods: The ability to set up an interdisciplinary multi-organisational team quickly, covering expert knowledge from clinical, legal, statistical, and computer science was essential. The technical infra-structure allows clinician-led anonymised data entry and rapid dissemination of results with a clinical (RedCap) database as core. However the development of a national cancer reporting network was crucial for the viability of the project. From its inception in March 2020 the reporting network was established via 4 iterative phases. Results: Within the first 4 weeks, >50 centres were involved with coverage throughout the UK. Expansion has continued with >70 centres within 6 weeks reporting over 1200 COVID positive cancer patients. This was achieved through a 4-phase approach: phase 1 - Outline: This involved project protocol development where key data and timelines were confirmed by a small project team followed by whole-team sign-off. phase 2 - Engagement: This involved identification and engagement of existing groups to establish an initial network. Professional body endorsement led to increased recognition and utilisation of their membership networks. Finally regional leads were identified. phase 3 - Invitation: The third phase involved the distribution of a formal invite letter via identified networks. Project specific email and standard mailing lists were created to enhance network identity and communication. phase 4 - Consolidation: Early development of an interactive project website and focus on communication via social media with varied content consolidated interest and led to further extension. Conclusions: Real-time reporting of real world data can be achieved with clearly defined project phases, standardised documentation and an iterative recruitment process. The COVID-19 pandemic necessitated a rapid response, proving that similar reporting networks can be set up quickly and robustly to react to the evidence-based needs of the oncology community in the drive for implementation of change. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.C. Olsson-Brown: Honoraria (self): Roche;Honoraria (institution): Roche;Honoraria (self): Bristol Myers Squibb;Research grant/Funding (institution): Bristol Myers Squibb;Research grant/Funding (institution): USB Pharma;Research grant/Funding (institution): Eli Lily;Research grant/Funding (institution): Novartis. D.J. Hughes: Honoraria (self): Novartis;Research grant/Funding (self): NanoMab Technology LtD. S. Sivakumar: Research grant/Funding (self): Celgene. All other authors have declared no conflicts of interest.