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Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study.
Pinato, David J; Scotti, Lorenza; Gennari, Alessandra; Colomba-Blameble, Emeline; Dolly, Saoirse; Loizidou, Angela; Chester, John; Mukherjee, Uma; Zambelli, Alberto; Aguilar-Company, Juan; Bower, Mark; Galazi, Myria; Salazar, Ramon; Bertuzzi, Alexia; Brunet, Joan; Mesia, Ricard; Sita-Lumsden, Ailsa; Colomba, Johann; Pommeret, Fanny; Seguí, Elia; Biello, Federica; Generali, Daniele; Grisanti, Salvatore; Rizzo, Gianpiero; Libertini, Michela; Moss, Charlotte; Evans, Joanne S; Russell, Beth; Wuerstlein, Rachel; Vincenzi, Bruno; Bertulli, Rossella; Ottaviani, Diego; Liñan, Raquel; Marrari, Andrea; Carmona-García, M C; Sng, Christopher C T; Tondini, Carlo; Mirallas, Oriol; Tovazzi, Valeria; Fotia, Vittoria; Cruz, Claudia A; Saoudi-Gonzalez, Nadia; Felip, Eudald; R Lloveras, Ariadna; Lee, Alvin J X; Newsom-Davis, Thomas; Sharkey, Rachel; Chung, Chris; García-Illescas, David; Reyes, Roxana.
  • Pinato DJ; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy. Electronic address: david.pinato@imperial.ac.uk.
  • Scotti L; Unit of Cancer Epidemiology, Department of Translational Medicine, CPO-Piemonte, University of Piemonte Orientale, Novara, Italy.
  • Gennari A; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
  • Colomba-Blameble E; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
  • Dolly S; Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK.
  • Loizidou A; Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
  • Chester J; Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK; Medical Oncology, Velindre Cancer Centre, Cardiff, UK.
  • Mukherjee U; Medical Oncology, Barts Health NHS Trust, London, UK.
  • Zambelli A; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Aguilar-Company J; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain.
  • Bower M; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK.
  • Galazi M; Cancer Division, University College London Hospitals, London, UK.
  • Salazar R; Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain.
  • Bertuzzi A; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
  • Brunet J; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain.
  • Mesia R; Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain.
  • Sita-Lumsden A; Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK.
  • Colomba J; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
  • Pommeret F; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
  • Seguí E; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain.
  • Biello F; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
  • Generali D; Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
  • Grisanti S; Medical Oncology Unit, Spedali Civili, Brescia, Italy.
  • Rizzo G; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Libertini M; Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
  • Moss C; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
  • Evans JS; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK.
  • Russell B; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
  • Wuerstlein R; Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany.
  • Vincenzi B; Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  • Bertulli R; Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Ottaviani D; Cancer Division, University College London Hospitals, London, UK.
  • Liñan R; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain.
  • Marrari A; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
  • Carmona-García MC; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain.
  • Sng CCT; Cancer Division, University College London Hospitals, London, UK.
  • Tondini C; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Mirallas O; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain.
  • Tovazzi V; Medical Oncology Unit, Spedali Civili, Brescia, Italy.
  • Fotia V; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Cruz CA; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain.
  • Saoudi-Gonzalez N; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain.
  • Felip E; Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain.
  • R Lloveras A; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain.
  • Lee AJX; Cancer Division, University College London Hospitals, London, UK.
  • Newsom-Davis T; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK.
  • Sharkey R; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK.
  • Chung C; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK.
  • García-Illescas D; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain.
  • Reyes R; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain.
Eur J Cancer ; 150: 190-202, 2021 06.
Article in English | MEDLINE | ID: covidwho-1208897
ABSTRACT

BACKGROUND:

Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU.

METHODS:

We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models.

FINDINGS:

Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts.

INTERPRETATION:

UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Neoplasms Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Cancer Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Neoplasms Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Cancer Year: 2021 Document Type: Article