Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer : a European study

Copyright © 2021 Elsevier Ltd. All rights reserved..

BACKGROUND: Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU.

METHODS: We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models.

FINDINGS: Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts.

INTERPRETATION: UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.


CommentIn: Lancet Oncol. 2021 Jun;22(6):755. - PMID 33894836

Media Type:

Electronic Article

Year of Publication:


Contained In:

European journal of cancer (Oxford, England : 1990) - Vol. 150 (2021), p. 190-202




Pinato, David J
Scotti, Lorenza
Gennari, Alessandra
Colomba-Blameble, Emeline
Dolly, Saoirse
Loizidou, Angela
Chester, John
Mukherjee, Uma
Zambelli, Alberto
Aguilar-Company, Juan
Bower, Mark
Galazi, Myria
Salazar, Ramon
Bertuzzi, Alexia
Brunet, Joan
Mesia, Ricard
Sita-Lumsden, Ailsa
Colomba, Johann
Pommeret, Fanny
Seguí, Elia
Biello, Federica
Generali, Daniele
Grisanti, Salvatore
Rizzo, Gianpiero
Libertini, Michela
Moss, Charlotte
Evans, Joanne S
Russell, Beth
Wuerstlein, Rachel
Vincenzi, Bruno
Bertulli, Rossella
Ottaviani, Diego
Liñan, Raquel
Marrari, Andrea
Carmona-García, M C
Sng, Christopher C T
Tondini, Carlo
Mirallas, Oriol
Tovazzi, Valeria
Fotia, Vittoria
Cruz, Claudia A
Saoudi-Gonzalez, Nadia
Felip, Eudald
R Lloveras, Ariadna
Lee, Alvin J X
Newsom-Davis, Thomas
Sharkey, Rachel
Chung, Chris
García-Illescas, David
Reyes, Roxana
Sophia Wong, Yien N
Ferrante, Daniela
Marco-Hernández, Javier
Ruiz-Camps, Isabel
Gaidano, Gianluca
Patriarca, Andrea
Sureda, Anna
Martinez-Vila, Clara
Sanchez de Torre, Ana
Rimassa, Lorenza
Chiudinelli, Lorenzo
Franchi, Michela
Krengli, Marco
Santoro, Armando
Prat, Aleix
Tabernero, Josep
V Hemelrijck, Mieke
Diamantis, Nikolaos
Cortellini, Alessio
OnCovid study group




Journal Article
Middle Aged
Research Support, Non-U.S. Gov't
United Kingdom


Date Completed 28.05.2021

Date Revised 08.06.2021

published: Print-Electronic

CommentIn: Lancet Oncol. 2021 Jun;22(6):755. - PMID 33894836

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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