UK Cancer Patients 'More Likely to Die From COVID-19'

Liam Davenport

June 15, 2021

UK cancer patients were significantly more likely to die from COVID-19 infection than their counterparts in the European Union (EU), even after taking into account their age, tumour stage, and COVID-19 severity, suggests a UK data analysis.

The results highlight that UK cancer patients are a "high-risk" group that "should be prioritised" for COVID-19 vaccination as the pandemic continues to evolve, say Dr David Pinato, Department of Surgery and Cancer, Imperial College, London, and colleagues.

The team looked at data on nearly 1000 EU cancer patients and almost 500 from the UK who contracted COVID-19 during the first wave of the pandemic, finding that the UK cohort had a higher risk profile and were less likely to receive both anti-cancer and anti-COVID therapies.

Even after taking that into account, UK cancer patients with COVID-19 were 64% more likely to die at 30 days and 59% more likely to die at 6 months than their EU counterparts.

The research was presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting on June 4, and recently published in the European Journal of Cancer.

Concerning Differences

Speaking to Medscape News UK, Dr Pinato said, reviewing the results, the team were "all very concerned about the difference".

However, he noted that the UK patients were older and had more comorbidities than their EU counterparts, and so "this is somehow not surprising".

"There is a lot of epidemiological evidence looking at cancer outcomes in general in the UK versus other industrialised countries," he continued, "and it is not the first time that we find that UK patients are maybe a bit more disadvantaged in terms of survival."

Dr Pinato said: "We feel, in general, that in particular [the] comorbid burden is one of the factors that perhaps might be more typical of UK patients…and this is probably one of the reasons why the mortality was higher."

Consequently, as a potential third wave of the pandemic approaches, "we now know that the UK, compared with many other countries, probably has an excess of patients with characteristics of frailty," he added.

"And if we were to plan services going forward, those are definitely the patients who should be characterised by a more stringent vaccination and follow-up programme."

Regarding the observation that UK patients were less likely to receive anti-COVID therapies, Dr Pinato noted that "this might reflect our own prescribing culture in the UK".

In addition, the data were from the first wave of the pandemic, when "there was very little level 1 evidence to guide any formal evidence-based treatment decision in patients with COVID", he said. Also, many of the drugs were "expensive".

"I don’t see the possibility in the NHS to have access to costly drugs in the absence of very strong clinical trial data," he said. "It’s probably one of the features of our system that unless you have very solid evidence…you won’t get funding."

The researchers note that, despite the "high contagiousness and rapid spread" of COVID-19, the outcomes across affected nations have been "heterogeneous", although it has become clear that the virus disproportionately affects older individuals and those with comorbidities.

Anti-cancer therapy does not appear to worsen the prognosis of COVID-19, but the immunosuppressive effect, the need for regular hospital attendance and the risk of treatment-related adverse effects have led to a "more cautious delivery of oncological therapies" during the pandemic.

Retrospective Analysis

The UK is the most severely affected European country by the pandemic, with more than 152,000 deaths with COVID-19 on the death certificate, but the researchers say that it is "unknown whether the higher mortality observed in the general UK population translates into worse outcomes from COVID-19" in cancer patients.

Dr Pinato and colleagues therefore conducted a retrospective analysis of the OnCovid registry, gathering data on 924 cancer patients in the EU and 468 UK patients diagnosed with COVID-19 between 27 February and 10 September, 2020.

Patients in the UK were significantly more likely to be male than their EU counterparts, at 61.7% of the cohort versus 48.9% (p<0.0001), and were more likely to be aged at least 65 years, at 67.8% versus 58.3% (p=0.0006).

UK patients were also more likely than EU patients to have at least two comorbidities, at 62.6% versus 54.55% (p=0.0041).

Despite being less likely to have advanced cancer (p<0.0001) and equally likely to have an active malignancy (p=0.9996), UK patients were less likely to be receiving anti-cancer therapy when they contracted COVID-19, at 38.4% versus 59.6% among EU patients (p<0.0001).

UK patients were just as likely as their EU counterparts to have complicated COVID-19, intensive care admission, and use of mechanical ventilation. However, they were less likely to receive anti-COVID-19 therapies such as corticosteroids, antivirals and interleukin-6 antagonists, at 60.5% versus 74.7% (p<0.0001).

Overall, UK cancer patients with COVID-19 were more likely to die than EU patients, with case fatality rates 40.4% versus 26.5% at 30 days and 47.6% versus 33.3% at 6 months (p<0.0001).

Multivariate analysis taking into account imbalanced prognostic factors demonstrated that UK patients had a worse mortality risk at 30 days and at 6 months, independent of patient age, gender, tumour stage and status, number of comorbidities, COVID-19 severity, and receipt of anti-cancer or anti-COVID-19 therapy.

The team calculated that the hazard ratio for death at 30 days in UK versus EU patients was 1.64, while at 6 months the hazard ratio was 1.59 (p<0.0001 for both).

As the patients were from the first wave of the pandemic, "part of that mortality that we’re seeing might be due to the fact that the emergency services were overloaded with patients", Dr Pinato noted.

In contrast, the "way we handle COVID-19 now is dramatically different…and maybe there is an element of that mortality that also stems from, for example, testing capacity", which was, at the time, "limited".

That meant that many people were diagnosed when they presented to hospital with a severe form of the disease, "as opposed to basically diagnosing it when…you can do a lot more to prevent the natural progression of COVID".

No funding declared.

Dr Pinato discloses relationships with Bristol-Myers Squibb; Roche/Genentech; AstraZeneca; Da Volterra; EISAI; H3 Biomedicine; Mina Therapeutics; Bayer; Falk Pharma; ViiV Healthcare; GlaxoSmithKline (Inst); MSD Oncology.

American Society of Clinical Oncology Annual Meeting: Abstract 1574. Presented June 4.

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