Impact of COVID-19 on patients who received systemic anticancer treatment (SACT) during the COVID-19 outbreak; The Guy’s Cancer Centre experience


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Eirini Tsotra, Charalampos Gousis, Beth Russell, Charlotte Moss, Gincy George, Eleanor Jones, Pavetha Seeva, Aarani Devi, Jose Roca, Vasiliki Michalarea, Kamural Zaki, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Elinor Sawyer, Angela Swampillai, Mary Lei, Daniel Smith, Paul Ross, James Spicer, Sophie Papa, Anne Rigg, Ana Montes, Mieke Van Hemelrijck, Saoirse Dolly

Abstract

Background

Cancer patients receiving SACT are considered as high risk for COVID-19 severe infection and death. This had an impact on the selection of patients who received SACT during the outbreak of the pandemic but limited data is available. The aim of this study is to identify the COVID-19 infection rate, the severity of the infection and the mortality rate of patients receiving SACT.

Method

We reviewed all the patients who received SACT from 1st March 2020 to 31st May 2020 at Guy’s Cancer Centre. Demographic data (sex, age, socioeconomic status, ethnicity, performance status) and cancer characteristics (tumour type, stage, intent, line and type of treatment) were obtained. We identified the patients with laboratory confirmed infection (SARS-CoV-2 RNA detection by PCR) and assessed the risk of COVID-19 severe infection and related mortality.

Results

A total of 2154 patients received SACT during the 3 months of the study. 46 of them were diagnosed with COVID-19 (2.14%). The overall mortality rate was 26% in the COVID-19 positive group (6 COVID-related and 6 non-COVID-related deaths) compared to 4.2% in the COVID-19 negative group (89 deaths). Among patients diagnosed with COVID-19 there were 6 COVID-related deaths, 34 patients had severe and 6 mild pneumonia. Patients receiving chemotherapy had higher infection rate (3.5%) compared to immunotherapy (2.4%), targeted/biological treatment (0.6%) and combination therapy (1%). Patients with gastrointestinal cancer had the highest infection rate (3.4%), followed by central nervous system (3.1%), skin/head & neck/sarcoma (2.7%), lung (2.4%), breast (2.1%) and urological/gynaecological malignancies (1.1%). 53.8% of the COVID-19 patients who received chemotherapy were managed in the outpatient setting whereas 60% of the biological/targeted therapy, all the immunotherapy and all the combination therapy patients required hospitalisation.

Conclusion

COVID-19 infection rate remained low (2.14%) among our study population. Less immunosuppressive treatments such as immunotherapy and targeted treatments had lower infection rates. Although the overall rate remained low, COVID-19 infection was associated with severe pneumonia and increased mortality in cancer patients receiving SACT. 

Impact statement

These results could support decision making and assessment of risk-benefit for SACT choice in oncology patients amid the COVID-19 pandemic, however, larger cohorts are warranted to lead to a national consensus.