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Cited by 1,103COVID-19 and healthcare impactsCOVID-19 Clinical Research StudiesCOVID-19 Impact on Reproduction

COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

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Lee, Lennard YW, Cazier, Jean-Baptiste, Angelis, Vasileios, Arnold, Roland, Bisht, Vartika, Campton, Naomi A, Chackathayil, Julia, Cheng, Vinton WT +31 more·2020·The Lancet
DOI 10.1016/s0140-6736(20)31173-9PMC PMC7255715
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Abstract

Background Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.Methods In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.Findings From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56-10·02]; p<0·0001), being male (1·67 [1·19-2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36-2·80]; p<0·001) and cardiovascular disease (2·32 [1·47-3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81-1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.Interpretation Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.Funding University of Birmingham, University of Oxford.

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  • Older adults with cancer may be among the most vulnerable to the effects of COVID-19 due to their immunocompromised status and increased presence of comorbidities.

    “This is particularly true of older adults with cancer, who may be among the most vulnerable to the effects of COVID-19 due to their immunocompromised status and increased presence of comorbidities [1,2,3,4,5].”

    From The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review (2022) · cites this paper as [2]

    The Findings and Interpretation report that advancing age and comorbidities were associated with COVID-19 mortality among patients with cancer. They do not establish immunocompromised status as a reason for that vulnerability; the paper also found no significant increase in mortality associated with recent anticancer treatment. (LLM, conf=0.86)

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  • COVID-19 mortality rises with increasing age and with comorbidities.

    “While the virus affects people of all ages, data have consistently shown that mortality is higher with increasing age and comorbidities [[3], [4], [5], [6]].”

    From Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group (2020) · cites this paper as [3]

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  1. [13]Khleif SN Rixe O Skeel R Skeel's Handbook of cancer therapy 2016 Lippincott Williams and Wilkins Philiadelphia, PA, USA

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Authors
Lee, L. Y., Cazier, J.-B., Angelis, V., Arnold, R., Bisht, V., Campton, N. A., Chackathayil, J., Cheng, V. W., Curley, H. M., Fittall, M. W., Freeman-Mills, L., Gennatas, S., Goel, A., Hartley, S., Hughes, D. J., Kerr, D., Lee, A. J., Lee, R. J., McGrath, S. E., Middleton, C. P., Murugaesu, N., Newsom-Davis, T., Okines, A. F., Olsson-Brown, A. C., Palles, C., Pan, Y., Pettengell, R., Powles, T., Protheroe, E. A., Purshouse, K., Sharma-Oates, A., Sivakumar, S., Smith, A. J., Starkey, T., Turnbull, C. D., Várnai, C., Yousaf, N., Kerr, R., & Middleton, G.
Affiliations
  • University of Birmingham (GB)
  • Royal Marsden NHS Foundation Trust (GB)
  • St George’s University Hospitals NHS Foundation Trust (GB)
  • University of Leeds (GB)
  • Glasgow Royal Infirmary (GB)
  • King's College London (GB)
  • University of Oxford (GB)
  • University College London (GB)
  • University of Manchester (GB)
  • Chelsea and Westminster Hospital NHS Foundation Trust (GB)
  • Clatterbridge Cancer Centre NHS Foundation Trust (GB)
  • St George's, University of London (GB)
  • Barts Cancer Institute (GB)
  • Edinburgh Cancer Research (GB)
Corresponding author
Lee, Lennard YW
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-06
Volume
395
Issue
10241
Pages
1919-1926
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(20)31173-9
PMC
PMC7255715
OpenAlex
W3028965239
Cited by
1,103
References
13
Citations by year
2026: 12 · 2025: 35 · 2024: 68 · 2023: 136 · 2022: 196 · 2021: 404 · 2020: 248 · 2018: 2 · 2014: 1
FWCI
88.86
Type
journal article
Language
en
Update notices
erratum (2020-08-22)
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
  • Research Portal (Queen's University Belfast) (submittedVersion)
  • reponame:Expeditio Repositorio Institucional UJTL
Funders
  • Cancer Research UK (28990, 30195)
  • National Institute for Health and Care Research (CL-2018-06-001, CL-2018-18-002, CL-2018-02-002, CL-2018-11-002, CL-2019-13-006, ACF-2017-19-002)
  • University of Oxford
  • University of Birmingham
  • Medical Research Council (MR/K017047/1, MR/N025989/1)
Topics
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
Keywords
COVID-19 pandemic, cancer, mortality, chemotherapy, cytotoxic chemotherapy, anticancer treatment, comorbidities, age, sex differences, hypertension, cardiovascular disease, hospital discharge, mortality risk factors
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Age Factors, Aged, Antineoplastic Agents, Cause of Death, Female, Humans, Male, Middle Aged, Neoplasms, Pneumonia, Viral, Prospective Studies, Risk Factors, Sex Factors, Comorbidity, Coronavirus Infections, Pandemics

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