Determinants of enhanced vulnerability to COVID-19 in UK cancer patients: 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. Carmen; Sng, Christopher CT.; Tondini, Carlo; Mirallas, Oriol; Tovazzi, Valeria; Fotia, Vittoria; Cruz, Claudia Andrea; Saoudi-Gonzalez, Nadia; Felip, Eudald; Roqué Lloveras, Ariadna; Lee, Alvin J.X.; Newsom-Davis, Thomas; Sharkey, Rachel; Chung, Chris; García-Illescas, David; Reyes, Roxana; Sophia Wong, Yien Ning; Ferrante, Daniela; Marco-Hernández, Javier; Ruiz-Camps, Isabel; Gaidano, Gianluca; Patriarca, Andrea; Sureda, Anna; Martinez-Vila, Clara; Sanchez de Torre, Ana; Rimassa, Lorenza; Chiudinelli, Lorenzo; Franchi, Michela; Krengli, Marco; Santoro, Armando; Prat, Aleix; Tabernero, Josep; Van Hemelrijck, Mieke; Diamantis, Nikolaos; Cortellini, Alessio

BACKGROUND: Despite high contagiousness and rapid spread, SARS-CoV-2 has led to heterogeneous outcomes across affected nations. Within Europe, 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 COVID-19 on the risk of death in UK cancer patients versus those in continental Europe (EU). METHODS: We performed a retrospective analysis of the OnCovid study database, a European registry of cancer patients consecutively diagnosed with COVID-19 in 27 centres from February 27 to September 10, 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 adverse outcome in multivariable Cox regression models. FINDINGS: Compared to EU (n=924), UK patients (n=468) were characterised by higher case fatality rates (40.38% versus 26.5%, p<0.0001), higher risk of death at 30 days (hazard ratio, HR 1.64 [95%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 males, of older age and more co-morbid than EU counterparts (p<0.01). Receipt of anticancer therapy was lower in UK versus EU patients (p<0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK cancer patients were less likely to receive anti-COVID-19 therapies including corticosteroids, anti-virals 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 patient’s age, gender, tumour stage and status, number of co-morbidities, COVID-19 severity, receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy post COVID-19 were similar in UK versus EU. INTERPRETATION: UK cancer patients 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 cancer patients highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.