Abstract 1704P
Background
The COVID-19 (C19) pandemic has prompted alterations to systemic anti-cancer therapy (SACT) due to concerns of immunosuppression and healthcare exposure. However, the effects of SACT on mortality in patients who acquire C19 are not well understood. As a national cancer centre within a major C19 hotspot, we seek to address these risks at scale.
Methods
Patients with a history of solid cancers and laboratory confirmed C19 (1 Mar to 31 May 2020) were included. Haematological malignancies were excluded. The primary outcome was time from C19 diagnosis to death. The last follow-up date was 22 Jun 2020.
Results
We identified 94 cancer patients; 62 males (median age 73, BMI 24.9), and 32 females (median age 68.5, BMI 25.7). Genitourinary (n = 24) cancers were the most common, followed by gastrointestinal (n = 23), thoracic (n = 15), and gynaecological (n = 9) cancers. 25 patients received SACT: chemotherapy (n = 15), endocrine therapy (n = 8), immunotherapy (n = 4), and targeted anti-cancer therapy (n = 2). 16 patients received SACT with palliative intent. Patients on SACT had a greater incidence of metastatic disease (48.0% vs 10.6%, p <0.001) and were younger (median age 62.5 vs 73.0, p = 0.01). They were also more likely to have renal impairment (p = 0.02), lymphopaenia (p = 0.01) and anaemia (p = 0.04) compared to those not on SACT. The univariate analysis showed age and co-morbidities were associated with mortality (Table). Adjusting for age, ethnicity, co-morbidities and the presence of metastatic cancer, SACT was an independent risk factor for C19 mortality (HR 2.46, 1.09 – 5.5, p = 0.03). Age, South Asian ethnicity, hypertension and cerebrovascular disease were also independent risk factors for C19 mortality. Table: 1704P
Univariate analysis of key variables associated with COVID-19 mortality
| Variable | Alive (53) | Dead (41) | p-value |
| Systemic anti-cancer therapy * | 13 / 24.5% | 12 / 28.3% | 0.81 |
| Age (years) ¶ | 66 (17) | 78 (11) | <0.01 |
| C-reactive protein (mg/L) ¶ | 60.4 (87) | 183.7 (215.3) | <0.01 |
| Hypertension* | 16 / 30% | 21 / 51% | 0.04 |
| Cardiovascular disease * | 8 / 15% | 10 / 24% | 0.25 |
| Lymphocytes (109/L) ¶ | 0.85 (0.68) | 0.66 (0.57) | 0.07 |
| Creatinine (μmol/L) ¶ | 79 (30) | 83.5 (64.7) | 0.44 |
| Haemoglobin (g/L) ¶ | 121 (18) | 116 (29) | 0.29 |
| Leukocytes (109/L) ¶ | 7.15 (4.03) | 9.35 (7.46) | 0.23 |
| Neutrophils (109/L) ¶ | 5.53 (3.88) | 7.52 (5.91) | 0.14 |
* shown as n / %. ¶ shown as median (IQR)
Conclusions
C19 infection poses a substantial risk to cancer patients and our data suggests that SACT is an independent risk factor for mortality in C19 infection. These findings call for a nuanced approach to C19 risk, focusing on established risk factors such as age and co-morbidities to guide treatment decisions.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
University College London Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.