key: cord-0951391-x66wizi6
authors: Várnai, Csilla; Palles, Claire; Arnold, Roland; Curley, Helen M.; Purshouse, Karin; Cheng, Vinton W. T.; Booth, Stephen; Campton, Naomi A.; Collins, Graham P.; Hughes, Daniel J.; Kulasekararaj, Austin G.; Lee, Alvin J. X.; Olsson-Brown, Anna C.; Sharma-Oates, Archana; Van Hemelrijck, Mieke; Lee, Lennard Y. W.; Kerr, Rachel; Middleton, Gary; Cazier, Jean-Baptiste
title: Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19
date: 2022-02-21
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2022.0130
sha: 241371924c6451d8372547dfa800c849d4813f01
doc_id: 951391
cord_uid: x66wizi6

IMPORTANCE: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. OBJECTIVE: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. DESIGN, SETTING, AND PARTICIPANTS: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. EXPOSURES: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. MAIN OUTCOMES AND MEASURES: The primary end point was all-cause mortality within the primary hospitalization. RESULTS: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). CONCLUSIONS AND RELEVANCE: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.

Drug names patients received in the 4 weeks before testing positive for COVID-19 and how they were categorized for analysis of the impact of SACT. Where possible drug regimens have been split apart into the drugs that make up the regimen. Patients only receiving supportive treatment were considered to be not on treatment in the 4 weeks prior to COVID-19 diagnosis. 

International Statistical Classification of Diseases and Related Health Problems 10th Revision

Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium