tetano
Editor, Senior Moderator
Eur J Cancer
. 2021 Apr 6;150:190-202.
doi: 10.1016/j.ejca.2021.03.035. Online ahead of print.
Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study
David J Pinato[SUP] 1 [/SUP], Lorenza Scotti[SUP] 2 [/SUP], Alessandra Gennari[SUP] 3 [/SUP], Emeline Colomba-Blameble[SUP] 4 [/SUP], Saoirse Dolly[SUP] 5 [/SUP], Angela Loizidou[SUP] 6 [/SUP], John Chester[SUP] 7 [/SUP], Uma Mukherjee[SUP] 8 [/SUP], Alberto Zambelli[SUP] 9 [/SUP], Juan Aguilar-Company[SUP] 10 [/SUP], Mark Bower[SUP] 11 [/SUP], Myria Galazi[SUP] 12 [/SUP], Ramon Salazar[SUP] 13 [/SUP], Alexia Bertuzzi[SUP] 14 [/SUP], Joan Brunet[SUP] 15 [/SUP], Ricard Mesia[SUP] 16 [/SUP], Ailsa Sita-Lumsden[SUP] 5 [/SUP], Johann Colomba[SUP] 4 [/SUP], Fanny Pommeret[SUP] 4 [/SUP], Elia Segu?[SUP] 17 [/SUP], Federica Biello[SUP] 3 [/SUP], Daniele Generali[SUP] 18 [/SUP], Salvatore Grisanti[SUP] 19 [/SUP], Gianpiero Rizzo[SUP] 20 [/SUP], Michela Libertini[SUP] 21 [/SUP], Charlotte Moss[SUP] 22 [/SUP], Joanne S Evans[SUP] 23 [/SUP], Beth Russell[SUP] 22 [/SUP], Rachel Wuerstlein[SUP] 24 [/SUP], Bruno Vincenzi[SUP] 25 [/SUP], Rossella Bertulli[SUP] 26 [/SUP], Diego Ottaviani[SUP] 12 [/SUP], Raquel Li?an[SUP] 15 [/SUP], Andrea Marrari[SUP] 14 [/SUP], M C Carmona-Garc?a[SUP] 15 [/SUP], Christopher C T Sng[SUP] 12 [/SUP], Carlo Tondini[SUP] 9 [/SUP], Oriol Mirallas[SUP] 27 [/SUP], Valeria Tovazzi[SUP] 19 [/SUP], Vittoria Fotia[SUP] 9 [/SUP], Claudia A Cruz[SUP] 17 [/SUP], Nadia Saoudi-Gonzalez[SUP] 27 [/SUP], Eudald Felip[SUP] 16 [/SUP], Ariadna R Lloveras[SUP] 15 [/SUP], Alvin J X Lee[SUP] 12 [/SUP], Thomas Newsom-Davis[SUP] 11 [/SUP], Rachel Sharkey[SUP] 11 [/SUP], Chris Chung[SUP] 23 [/SUP], David Garc?a-Illescas[SUP] 27 [/SUP], Roxana Reyes[SUP] 17 [/SUP], Yien N Sophia Wong[SUP] 12 [/SUP], Daniela Ferrante[SUP] 2 [/SUP], Javier Marco-Hern?ndez[SUP] 28 [/SUP], Isabel Ruiz-Camps[SUP] 29 [/SUP], Gianluca Gaidano[SUP] 30 [/SUP], Andrea Patriarca[SUP] 30 [/SUP], Anna Sureda[SUP] 31 [/SUP], Clara Martinez-Vila[SUP] 32 [/SUP], Ana Sanchez de Torre[SUP] 33 [/SUP], Lorenza Rimassa[SUP] 34 [/SUP], Lorenzo Chiudinelli[SUP] 9 [/SUP], Michela Franchi[SUP] 9 [/SUP], Marco Krengli[SUP] 35 [/SUP], Armando Santoro[SUP] 34 [/SUP], Aleix Prat[SUP] 36 [/SUP], Josep Tabernero[SUP] 37 [/SUP], Mieke V Hemelrijck[SUP] 38 [/SUP], Nikolaos Diamantis[SUP] 8 [/SUP], Alessio Cortellini[SUP] 39 [/SUP], OnCovid study group
Affiliations
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
, 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.
Keywords: COVID-19; Cancer; Europe; Mortality; SARS-CoV-2; UK.
. 2021 Apr 6;150:190-202.
doi: 10.1016/j.ejca.2021.03.035. Online ahead of print.
Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study
David J Pinato[SUP] 1 [/SUP], Lorenza Scotti[SUP] 2 [/SUP], Alessandra Gennari[SUP] 3 [/SUP], Emeline Colomba-Blameble[SUP] 4 [/SUP], Saoirse Dolly[SUP] 5 [/SUP], Angela Loizidou[SUP] 6 [/SUP], John Chester[SUP] 7 [/SUP], Uma Mukherjee[SUP] 8 [/SUP], Alberto Zambelli[SUP] 9 [/SUP], Juan Aguilar-Company[SUP] 10 [/SUP], Mark Bower[SUP] 11 [/SUP], Myria Galazi[SUP] 12 [/SUP], Ramon Salazar[SUP] 13 [/SUP], Alexia Bertuzzi[SUP] 14 [/SUP], Joan Brunet[SUP] 15 [/SUP], Ricard Mesia[SUP] 16 [/SUP], Ailsa Sita-Lumsden[SUP] 5 [/SUP], Johann Colomba[SUP] 4 [/SUP], Fanny Pommeret[SUP] 4 [/SUP], Elia Segu?[SUP] 17 [/SUP], Federica Biello[SUP] 3 [/SUP], Daniele Generali[SUP] 18 [/SUP], Salvatore Grisanti[SUP] 19 [/SUP], Gianpiero Rizzo[SUP] 20 [/SUP], Michela Libertini[SUP] 21 [/SUP], Charlotte Moss[SUP] 22 [/SUP], Joanne S Evans[SUP] 23 [/SUP], Beth Russell[SUP] 22 [/SUP], Rachel Wuerstlein[SUP] 24 [/SUP], Bruno Vincenzi[SUP] 25 [/SUP], Rossella Bertulli[SUP] 26 [/SUP], Diego Ottaviani[SUP] 12 [/SUP], Raquel Li?an[SUP] 15 [/SUP], Andrea Marrari[SUP] 14 [/SUP], M C Carmona-Garc?a[SUP] 15 [/SUP], Christopher C T Sng[SUP] 12 [/SUP], Carlo Tondini[SUP] 9 [/SUP], Oriol Mirallas[SUP] 27 [/SUP], Valeria Tovazzi[SUP] 19 [/SUP], Vittoria Fotia[SUP] 9 [/SUP], Claudia A Cruz[SUP] 17 [/SUP], Nadia Saoudi-Gonzalez[SUP] 27 [/SUP], Eudald Felip[SUP] 16 [/SUP], Ariadna R Lloveras[SUP] 15 [/SUP], Alvin J X Lee[SUP] 12 [/SUP], Thomas Newsom-Davis[SUP] 11 [/SUP], Rachel Sharkey[SUP] 11 [/SUP], Chris Chung[SUP] 23 [/SUP], David Garc?a-Illescas[SUP] 27 [/SUP], Roxana Reyes[SUP] 17 [/SUP], Yien N Sophia Wong[SUP] 12 [/SUP], Daniela Ferrante[SUP] 2 [/SUP], Javier Marco-Hern?ndez[SUP] 28 [/SUP], Isabel Ruiz-Camps[SUP] 29 [/SUP], Gianluca Gaidano[SUP] 30 [/SUP], Andrea Patriarca[SUP] 30 [/SUP], Anna Sureda[SUP] 31 [/SUP], Clara Martinez-Vila[SUP] 32 [/SUP], Ana Sanchez de Torre[SUP] 33 [/SUP], Lorenza Rimassa[SUP] 34 [/SUP], Lorenzo Chiudinelli[SUP] 9 [/SUP], Michela Franchi[SUP] 9 [/SUP], Marco Krengli[SUP] 35 [/SUP], Armando Santoro[SUP] 34 [/SUP], Aleix Prat[SUP] 36 [/SUP], Josep Tabernero[SUP] 37 [/SUP], Mieke V Hemelrijck[SUP] 38 [/SUP], Nikolaos Diamantis[SUP] 8 [/SUP], Alessio Cortellini[SUP] 39 [/SUP], OnCovid study group
Affiliations
- PMID: 33932726
- DOI: 10.1016/j.ejca.2021.03.035
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
, 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.
Keywords: COVID-19; Cancer; Europe; Mortality; SARS-CoV-2; UK.