Abstract 1734P
Background
The COVID-19 pandemic remains of pressing concern for patients with cancer. Mortality from COVID-19 is predicted by age and co-morbidities, but the relative contribution of cancer is poorly understood. As a tertiary academic hospital serving a large general and cancer population in a COVID-19 epicentre, we are uniquely placed to investigate this. We report data from our study, comparing cancer patients to an age- and sex-matched non-cancer cohort.
Methods
Patients with laboratory confirmed COVID-19 from 1 March to 31 May 2020 were included. Patients with a history of solid cancer were compared to an age- and sex-matched non-cancer cohort. Patients with haematological malignancies were excluded.
Results
We identified 94 patients with cancer and 226 patients without cancer. In univariate analysis, age, South Asian ethnicity and co-morbidities predicted mortality (see table). More in the cancer cohort had died compared to the non-cancer cohort (43.6% vs 34.1%). The higher mortality among cancer patients was statistically significant among those aged 70 years and above (OR 2.28, 1.14-4.50, p = 0.02). After adjusting for age, ethnicity and co-morbidities, a history of cancer was an independent predictor of mortality following COVID-19 (HR 1.57, 95% CI:1.04-2.4, p = 0.03). Patients with active malignancy also had similarly increased adjusted mortality (HR 1.64, 95% CI: 1.03 – 2.6, p = 0.04). Increasing age (HR 1.49 every 10 years, 95% CI:1.25-1.8, p <0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73-4.9, p <0.001) and cerebrovascular disease (HR 1.93, 95% CI:1.18-3.2, p = 0.008) were also confirmed as independent predictors of mortality. Table: 1734P
Univariate analysis of risk factors for mortality in COVID-19
| Variable | Alive | Dead | p-value |
| Age (years) ¶ | 67.0 (56.3 - 78.0) | 75.0 (68.3 - 83.0) | <0.01 |
| South Asian ethnicity * | 16 / 8% | 20 / 17% | 0.03 |
| Cardiovascular disease * | 41/ 20% | 36 / 31% | 0.04 |
| Cerebrovascular disease * | 23 / 11% | 26 / 22% | 0.02 |
| Chronic kidney disease * | 17 / 8% | 21 / 18% | 0.02 |
| Hypertension * | 92 / 46% | 68 / 58% | <0.05 |
* shown as n / %. ¶ shown as median (IQR)
Conclusions
Along with known risk factors, cancer confers an independent risk for mortality in COVID-19. Taken together, our findings support the need to continue ‘shielding’ patients with cancer from exposure to COVID-19 infection. Increasing age and co-morbidity should take precedence when weighing up risk factors for severe COVID-19 infection in cancer patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
University College London Hospitals NHS Foundation Trust.
Funding
Has not received any funding.
Disclosure
H.M. Shaw: Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis, BMS, MSD; Advisory/Consultancy: Immunocore, Idera, Iovance, Genmab, Sanofi Genzyme/Regeneron, Macrogenics, Roche; Speaker Bureau/Expert testimony: Sanofi Genzyme. All other authors have declared no conflicts of interest.