COVID-19 in cancer patients on systemic anti-cancer therapies: outcomes from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study

Valerie E Crolley; Daire Hanna; Nalinie Joharatnam-Hogan; Neha Chopra; Ekin Bamac; Meera Desai; Yuk-Chun Lam; Sabiq Dipro; Ruhi Kanani; Jack Benson; William Wilson; Thomas A Fox; Kai-Keen Shiu; Martin Forster; John Bridgewater; Daniel Hochhauser; Khurum Khan

doi:10.1177/1758835920971147

COVID-19 in cancer patients on systemic anti-cancer therapies: outcomes from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study

Ther Adv Med Oncol. 2020 Oct 23:12:1758835920971147. doi: 10.1177/1758835920971147. eCollection 2020.

Authors

Valerie E Crolley¹, Daire Hanna², Nalinie Joharatnam-Hogan², Neha Chopra², Ekin Bamac², Meera Desai², Yuk-Chun Lam², Sabiq Dipro¹, Ruhi Kanani¹, Jack Benson¹, William Wilson³, Thomas A Fox², Kai-Keen Shiu², Martin Forster², John Bridgewater², Daniel Hochhauser², Khurum Khan⁴

Affiliations

¹ North Middlesex University Hospital, London, UK.
² University College NHS Foundation Trust, London, UK.
³ Cancer Research UK, Oxford, UK.
⁴ Gastrointestinal Oncology Service and Cancer of Unknown Primary Service, University College London Hospital, UCL Cancer Institute and North Middlesex University Hospital, GI Cancer Lead North London Cancer Research Network and Oncology Research Lead North Middlesex University Hospital, 250 Euston Rd, London NW1 2PG, UK North Middlesex University Hospital, London, UK UCL Cancer Institute, 72 Huntley St, Bloomsbury, London WC1E 6DD, UK.

Abstract

Background: Patients with cancer are hypothesised to be at increased risk of contracting COVID-19, leading to changes in treatment pathways in those treated with systemic anti-cancer treatments (SACT). This study investigated the outcomes of patients receiving SACT to assess whether they were at greater risk of contracting COVID-19 or having more severe outcomes.

Methods: Data was collected from all patients receiving SACT in two cancer centres as part of CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London). The primary outcome was the effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT. We used univariable and multivariable models to analyse outcomes, adjusting for age, gender and comorbidities.

Results: A total of 2871 patients receiving SACT from 2 March to 31 May 2020 were analysed; 68 (2.4%) were diagnosed with COVID-19. Cancer patients receiving SACT were more likely to die if they contracted COVID-19 than those who did not [adjusted (adj.) odds ratio (OR) 9.84; 95% confidence interval (CI) 5.73-16.9]. Receiving chemotherapy increased the risk of developing COVID-19 (adj. OR 2.99; 95% CI = 1.72-5.21), with high dose chemotherapy significantly increasing risk (adj. OR 2.36, 95% CI 1.35-6.48), as did the presence of comorbidities (adj. OR 2.29; 95% CI 1.19-4.38), and having a respiratory or intrathoracic neoplasm (adj. OR 2.12; 95% CI 1.04-4.36). Receiving targeted treatment had a protective effect (adj. OR 0.53; 95% CI 0.30-0.95). Treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers had no significant effect on risk.

Conclusion: Patients on SACT are more likely to die if they contract COVID-19. Those on chemotherapy, particularly high dose chemotherapy, are more likely to contract COVID-19, while targeted treatment appears to be protective.

Keywords: COVID-19; SACT; SARS-CoV-2; cancer; chemotherapy; coronavirus; hormone therapy; immunotherapy; novel coronavirus; oncology; systemic anti-cancer treatment; targeted treatment; tumour.