COVID-19 incidence and mortality and effect of primary tumour 1 subtype and patient demographics: a prospective cancer cohort 2 study (UK CCMP) 3

Patients with a diagnosis of cancer are purported to have poor outcomes from COVID-19. However, cancer is a heterogeneous group of diseases encompassing a spectrum of tumour subtypes. The aim of this study is to evaluate COVID-19 risk according to tumour subtype and patient demographics in the cancer population. A comparison of adult cancer patients enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) from 62 18 th March to 8 th May and a parallel non-COVID-19 UK cancer control population cohort was performed, analysing effect of tumour subtype and patient demographics (age and sex) on the incidence and mortality from COVID-19 using univariate and multivariable models. In 1,044 patients with COVID-19, an overall case fatality rate of 0.31 was observed, of which 92.3% of deaths due to COVID-19. Age is a risk factor for COVID-19 with a Case fatality rate (CFR) in the 40-49, 50-59, 60-69, 70-79 and over 80 groups being 0.10, 0.17, 0.28, 0.35 and 0.48 respectively. Patients with haematological malignancies run a more severe COVID-19 trajectory (OR 1.57, 95% CI 1.15-2.15; p<0.01) compared to patients with solid organ tumours. CFR following COVID-19 in patients with leukaemia is increased compared to other cancer types, even considering other risk factors (OR 2.25, 95% CI [1.13 to 4.57]; p=0.02). in haematological patients associated with additional risk of death on multivariate analyses (OR 2.09 95% CI [1.09 to 4.08]; p=0.03). Cancer Monitoring (UKCCMP) database of United Kingdom (UK) cancer patients has been designed as a Public Health Surveillance registry for the COVID-19 pandemic and a prospective observational cohort study (10). The database was designed as a public health surveillance registry to support rapid clinical decision making, in accordance with the UK Policy Framework for Health and Social Care Research, the UK National Research Ethics Service, and the UK Governance Arrangement for Research Ethic Committees. At an institutional level, this cohort study was approved according to local information governance processes. All adult patients (18 and older) with active cancer and who presented to a cancer centre within the UKCCMP network from March 18 th 2020 with a positive SARS-CoV-2 test were eligible for enrolment on the registry. The patients presented for secondary care review for potential hospitalization and were not part of a proactive surveillance program. Patients with active cancer were defined as those with metastatic cancer, or those undergoing anti-cancer treatment in any setting (curative/radical/adjuvant/neoadjuvant) or those treated within the past 12 months with surgery/systemic anti-cancer therapies/radiotherapy. Management of cancer patients with COVID-19 was directed by the patient’s clinician team with out input from the UK CCMP and were based on local policies and standard UK clinical practice at the time of this study. Decisions on ITU admission and ventilation were guided by the UK National Health Service, National Institute of Health and Care Excellence COVID-19 rapid guidelines. (11) This study was conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) in patients (16), Our analyses on symptomatic cancer patients Therefore, the cohort may not be entirely representative of all patients with cancer, and observe a high proportion of advanced/metastatic disease, patients who are under ongoing active oncological It is also unlikely that patients on an end of life pathway or residing in nursing homes/hospices be included in this registry. There are potential limitations with the use of ONS control population of our comparator. In the presented study, re port on patients with current “active Cancer” the control a historical control, consisting of all patients with a diagnosis of cancer in 2017 and it is possible prognoses and therapeutic choices may have changed during this period. it be to perform analyses using more contemporaneous controls when these data become available. Other possible limitations include that performance status, patient co-morbidity scale/index and ethnicity were not initially collected as part of the study data entry form and therefore could not be used in multivariable models. However, COVID-19 in cancer patients remain thankfully low overall and the age distribution of patients in the reflects the age distribution in the ONS dataset suggesting that our comparator population is as appropriate as possible at this stage. PubMed all to SARS-CoV-2 infection susceptibility clinical course of coronavirus disease (COVID-19) in cancer patients. This used the search terms, COVID-19, SARS-CoV-2, cancer and was not limited to English language publications. Several studies describe the correlations of patient demographics, namely age and gender and increased COVID-19 morbidity and mortality including Docherty et al (2020), Robilotti et al (2020), Miyashita et al (2020). Two pivotal cancer cohorts have identified no significant effect of chemotherapy on mortality, Lee et al (2020), Kuderer et al (2020) and this was also noted by Vaugnat et al (2020). However, one small study had identified a small risk, Yang et al (2020). The effect of cancer subtype is unclear. Dai et al (2020) identified that patients with haematological or lung malignancies have disease course. The elevated risk in haematological malignancies was also noted by Yang et al (2020) and in lung cancer by Garassino et al (2020), but Kuderer et al (2020) did not identify increased mortality by cancer subtype. (primary Tumour (primary subtype stage) patient on susceptibility and COVID-19 disease phenotype. There is increased SARS-CoV-2 susceptibility in patients with haematological cancers (leukaemia/lymphoma/myeloma).