Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study

• Published in: The lancet oncology 2024-05, Vol.25 (5), p.636-648
• Main Authors: Turtle, Lance, Elliot, Sarah, Drake, Thomas M, Thorpe, Mathew, Khoury, Emma G, Greenhalf, William, Hardwick, Hayley E, Leeming, Gary, Law, Andy, Oosthuyzen, Wilna, Pius, Riinu, Shaw, Catherine A, Baillie, J Kenneth, Openshaw, Peter J M, Docherty, Annemarie B, Semple, Malcolm G, Harrison, Ewen M, Palmieri, Carlo
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Cancer therapies; Cohort analysis; Comorbidity; Consortia; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 vaccines; Data collection; Female; Gender; Hematology; Hospital Mortality; Hospitals; Humans; Immunization; Infections; Intensive care; Male; Medical research; Middle Aged; Mortality; Neoplasms - mortality; Neoplasms - therapy; Pandemics; Patients; Prospective Studies; Research ethics; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; United Kingdom - epidemiology; Vaccination; Ventilators
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(24)00107-4

Patients with cancer are at greater risk of dying from COVID-19 than many other patient groups. However, how this risk evolved during the pandemic remains unclear. We aimed to determine, on the basis of the UK national pandemic protocol, how factors influencing hospital mortality from COVID-19 could differentially affect patients undergoing cancer treatment. We also examined changes in hospital mortality and escalation of care in patients on cancer treatment during the first 2 years of the COVID-19 pandemic in the UK. We conducted a prospective cohort study of patients aged older than 19 years and admitted to 306 health-care facilities in the UK with confirmed SARS-CoV-2 infection, who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol (CCP) across the UK from April 23, 2020, to Feb 28, 2022; this analysis included all patients in the complete dataset when the study closed. The primary outcome was 30-day in-hospital mortality, comparing patients on cancer treatment and those without cancer. The study was approved by the South Central–Oxford C Research Ethics Committee in England (Ref: 13/SC/0149) and the Scotland A Research Ethics Committee (Ref 20/SS/0028), and is registered on the ISRCTN Registry (ISRCTN66726260). 177 871 eligible adult patients either with no history of cancer (n=171 303) or on cancer treatment (n=6568) were enrolled; 93 205 (52·4%) were male, 84 418 (47·5%) were female, and in 248 (13·9%) sex or gender details were not specified or data were missing. Patients were followed up for a median of 13 (IQR 6–21) days. Of the 6568 patients receiving cancer treatment, 2080 (31·7%) died at 30 days, compared with 30 901 (18·0%) of 171 303 patients without cancer. Patients aged younger than 50 years on cancer treatment had the highest age-adjusted relative risk (hazard ratio [HR] 5·2 [95% CI 4·0–6·6], p