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

Background: Data from the first wave of COVID-19 infection demonstrated that a history of cancer and SACT was associated with poorer outcomes. Our study compares outcomes for cancer patients matched to non-cancer patients between the two waves in order to explore further how cancer and its treatment may impact COVID-19 mortality. Methods: Data was collected for patients with positive PCR and history of cancer between 1 Mar to 20 May 2020 and 1 Dec to 8 Feb 2021 for wave 1 and 2, respectively. A contemporaneous cohort of patients without cancer were age- and sex-matched for comparison. Results: The total number of patients presenting with COVID-19 was higher in wave two (1135 vs 626). 207 of these patients had cancer, and were matched to 452 patients without cancer from both waves. There was a significantly improved chance of mortality in wave 2 (HR 0.41, p < 0.0001). When adjusting for age, sex and co-morbidities, cancer was an independent risk factor for mortality amongst patients hospitalised with COVID-19 in wave 1 (HR 1.62, p = 0.02), but not in wave 2. There was a trend towards improved survival for hospitalised patients in wave 2 receiving COVID-19 specific treatment including dexamethasone, remdesivir, tocilizumab (HR 0.75, p = 0.086). For the combined cancer cohort, SACT was an independent predictor of mortality, as was metastatic disease. [Formula presented] Conclusions: The mortality for both cancer and non-cancer patients improved between waves of the pandemic. Advances in detection, prevention and treatment may account for this. Cancer was no longer a risk factor for mortality in the second wave, however SACT and metastatic cancer remained risk factors for mortality within the cancer cohort. This emphasises the need for ongoing protection of patients with advanced cancer and those on SACT, including through their prioritisation for COVID-19 vaccination globally. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure H. Shaw Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Novartis;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy BMS;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy MSD;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Immunocore;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Idera;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Iovance;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Sanofi Genzyme/Regeneron;Financial Interests, Personal, Invited Speaker, Advisory/Consultancy Macrogenics;Financi Interests, Personal, Invited Speaker, Advisory/Consultancy Roche. R. Roylance Financial Interests, Personal, Other, Personal Fees Novartis;Financial Interests, Personal, Other, Personal Fees & None-financial support Daiichi Sankyo;Financial Interests, Personal, Other, Personal Fees Eli-Lilly;Financial Interests, Personal, Other, Personal Fees Pfizer;Financial Interests, Personal, Other, Personal Fees & None-financial support G1 Therapeutics;Non-Financial Interests, Personal, Other, None-financial support Roche;Non-Financial Interests, Personal, Other, None-financial support AstraZeneca. All other authors have declared no conflicts of interest.