Outcomes of the 2019 Novel Coronavirus in patients with or without a history of cancer - a multi-centre North London experience

Abstract

Background Four months after the first known case of the 2019 novel coronavirus disease (COVID-19), on the 11th March 2020, the WHO declared the outbreak a pandemic and acknowledged the potential to overwhelm national healthcare systems. The high prevalence and associated healthcare, social and economic challenges of COVID-19 suggest this pandemic is likely to have a major impact on cancer management, and has been shown to potentially have worse outcomes in this cohort of vulnerable patients (1). This study aims to compare the outcomes of reverse transcriptase polymerase chain reaction (RT-PCR) confirmed COVID-19 positive disease in patients with or without a history of cancer. Method: We retrospectively collected clinical, pathological and radiological characteristics and outcomes of COVID-19 RT-PCR positive cancer patients treated consecutively in four different North London hospitals (cohort A). Outcomes recorded included morbidity, mortality and length of hospital stay. All clinically relevant outcomes were then compared to consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (12th March- 7th April 2020). Results: A total of 52 electronic patient records during the study time period were reviewed. Cohort A (median age 76 years, 56% males) and cohort B (median age 58 years, 62% male) comprised of 26 patients each. With the exclusion of cancer, both had a median of 2 comorbidities. Within cohort A, the most frequent underlying cancer was colorectal (5/26) and prostate cancer (5/26), and 77% of patients in Cohort A had received previous anti-cancer therapy. The most common presenting symptoms were cough and pyrexia in both cohorts. Frequent laboratory findings included lymphopenia, anaemia and elevated CRP in both cohorts, whilst hypokalaemia, hypoalbuminaemia and hypoproteinaemia was predominantly seen amongst patients with cancer. Median duration of admission was 7 days in both cohorts. The mortality rate was the same in both cohorts (23%), with median age of mortality of 80 years. Of cancer patients who died, all were advanced stage, had been treated with palliative intent and had received anti-cancer therapy within 13 days of admission. Conclusion: Old age, late stage of cancer diagnosis and multiple co-morbidities adversely influence the outcome of patients with COVID-19 positive patients. Whilst extra caution is warranted in the administration of anti-cancer therapies pertaining to the risk of immune-suppression, this data does not demonstrate a higher risk to cancer patients compared to their non-cancer counterparts.

Mortality in patients with cancer and coronavirus disease 2019: A systematic review and pooled analysis of 52 studies

“…[ 2 ] Peer reviewed 27 1 10 Mar to 29 Apr 2020 Columbia University Irving Medical Center, USA Breast cancer only 42 Joharatnam-Hogan et al. [ 49 ] Preprint 26 6 12 Mar to 7 Apr 2020 London, UK Any 43 Stroppa et al. [ 50 ] Peer reviewed 25 9 21 Feb to 18 Mar 2020 Piacenza's general hospital, Italy Any 44 Ciceri et al.…”

COVID-19 cancer conundrum—evidence driving decisions or the lack of it?

“…A subsequent study from Wuhan comparing 105 patients with cancer to 536 agematched patients without cancer demonstrated a higher frequency of severe events related to COVID-19 particularly in patients with haematological malignancies, lung cancer, or metastatic disease [3]. Our group formed a North London collaboration of five hospitals and found no significant differences in mortality of two consecutive cohorts comprising of COVID-19 positive cancer and non-cancer patients [4]. It is possible there may be a confounding factor of chemotherapy-associated immunosuppression having a protective effect against some of the inflammatory processes of COVID-19 by virtue of dampening the cytokine storm.…”

COVID-19 and Its Impact on Upper Gastrointestinal (GI) Cancer Management

“…Our department published data on the outcomes of cancer patients infected with COVID-19, compared against non-cancer patients infected during the same time period. This was a collaboration of five North London hospitals comparing the outcomes of cancer patients infected with COVID-19, (Cohort A), against patients admitted with COVID-19, who did not have cancer, (Cohort B) [ 20 ]. The cohorts were matched in terms of age, sex and co-morbidities.…”