Blood cancer patients are most vulnerable to COVID-19

Analysis of cancer types from the UK Coronavirus Cancer Monitoring Project (UKCCMP) suggests that patients with cancer may have different degrees of risk from COVID19 depending on their cancer type and age.  Further, patients with leukaemia, lymphoma and myeloma may be more likely to catch COVID-19 and develop a severe disease when comparing patients with COVID19 with the overall cancer population.

The effect of cancer type

Researchers found that cancer type, as well as age and sex of the patient, influences the risk of catching COVID-19 and developing a more severe disease.

Patients with blood cancers, such as leukaemia, lymphoma and myeloma, are more likely to get COVID-19 and require more intensive treatment.

Researchers have also developed COVID-19 risk estimates based on patient tumour type, age and sex. They are designed to help clinicians and cancer patients make more informed decisions when selecting the most suitable treatment.

Susceptibility to COVID-19

The UKCCMP researchers looked at how over 1,000 cancer patients who had been reported to have COVID-19 compare to the overall population of cancer patients in the UK. This is the first detailed analysis of how cancer type together with age and sex influences COVID-19 risk and outcomes.

Compared to the overall cancer population, the risk for patients with leukaemia was almost three times higher. The risk for myeloma was around two times higher and for lymphoma around 1.6 times higher.

However, patients with lung and prostate cancers seemed to be less likely to get COVID-19. While 13% of all cancers in the UK are lung cancers, only 10.7% of cancer patients with COVID-19 taking part in the study had lung tumours. The proportion of prostate cancers was 14.6% versus 11%.

Cancer patients who develop COVID-19 were also more likely to be men.

Likelihood of dying from COVID-19

Researchers also evaluated factors determining how likely cancer patients are to die from COVID-19.

This was influenced by age, with older patients less likely to recover. Recovery also appeared to be linked to gender with women more likely to recover than men.

Most cancer types didn’t have an effect on the risk of dying from COVID-19 when other clinical factors, age and sex where taken into account. However, this was not the case for leukaemia. Patients with leukaemia were at an increased risk of dying from COVID-19.

Closer look at blood cancers

A detailed analysis of the data from 227 blood cancer patients who developed COVID-19 was also carried out.

Overall, blood cancer patients seemed to have similar symptoms to other cancer patients. However, they were more likely to require high flow oxygen or ventilation and develop a more severe disease.

Unlike the overall cancer patient population, patients with blood cancers who had chemotherapy within four weeks of developing COVID-19, were at higher risk of dying from the infection.

The study was published in the Lancet Oncology.

You can also read the press release issued by the University of Birmingham and the University of Oxford.

Recent chemotherapy treatment doesn’t increase risk of dying from COVID-19 in cancer patients

First results from the UK Coronavirus Cancer Monitoring Project (UKCCMP) suggest that receiving chemotherapy treatment within four weeks prior to COVID-19 infection doesn’t increase the likelihood of dying.

The effect of cancer treatments

Analysis of data gathered by the UKCCMP shows that cancer patients who received chemotherapy within four weeks before COVID-19 diagnosis were no more likely to die from the infection than cancer patients who didn’t receive chemotherapy.

Researchers also saw similar results for other cancer treatments. These include immunotherapy, hormone therapy, targeted treatments, and radiotherapy. Since the number of patients receiving these treatments was smaller, these observations will need to be further confirmed.

Scientists highlight that effective cancer treatments shouldn’t be withheld from significant numbers of cancer patients who need them during the pandemic.

What makes COVID-19 worse

Chemotherapy is known to weaken the immune system. This effect can last after the treatment has finished. Therefore, cancer patients receiving chemotherapy were thought to be at a higher risk of catching COVID-19 and developing a more severe illness.

Looking at first 800 cancer patients taking part in the project, researchers found that chemotherapy and other cancer treatments don’t play an important role. Instead, the chance of dying from COVID-19 is strongly influenced by age and other underlying health conditions.

Professor Gary Middleton, joint-senior author, said: “We hope this study will be reassuring for cancer patients, as to whether chemotherapy or anti-cancer treatments will increase their risk of dying from COVID-19.”

“Our data strongly shows that cancer COVID-19 mortality is principally driven by advancing age and the presence of other non-cancer co-morbidities.”

This is in line with what was already known about COVID-19.

Taking a closer look at chemotherapy

There are different types of chemotherapy. It can either be given to treat cancer or to keep it under control if it has spread and become incurable. Scientists carried out preliminary analyses to test whether they all have the same effect.

They found that cancer patients receiving chemotherapy to treat cancer were less likely to die from COVID-19 than those who were getting it to manage cancer and its symptoms. But patients receiving chemotherapy to manage cancer had a similar chance of dying from COVID-19 as cancer patients receiving no cancer treatment at all.

Joint-lead author Professor Jean-Baptiste Cazier said:

“This study demonstrates the power of the rapid integration of data from across the country to deliver actionable knowledge in near-real-time and inform clinicians and cancer patients, enabling them to make critical decisions in these challenging times.”

Next steps

Cancer treatments are known to affect the immune system in many different ways. In future, researchers hope to be able to investigate whether there is more to learn about specific treatments, the timing of cancer treatments and different cancer types.

“This project is a great illustration of what can be achieved by the UK oncology community. We have joined forces to learn from each other and answer the most pressing questions for cancer patients,” highlighted Dr Lennard Lee, joint-lead author.

“The UK CCMP projects will be crucial in providing the necessarily tools to enable to identify and mitigate risks to cancer patients now and in any possible pandemic phases. This will ensure the highest levels of cancer care will continue to be provided in the United Kingdom.”

The study was published in the journal The Lancet.

What we have learnt so far about cancer and COVID-19

The UK Coronavirus Cancer Monitoring Project has been collecting and analysing data from cancer patients with COVID-19 for seven weeks. Thanks to data from over 1,200 patients, we’re starting to gain new insight. Here’s what we’ve learned so far.

Younger patients do better

Younger patients with cancer and COVID-19 are more likely to recover and be discharged from hospital than older ones. This trend started emerging early on and is in line with what we already know about COVID-19.

While age can play a role in the severity of the infection, older people are also more likely to have other health conditions, which can make the infection harder to overcome. As we reported in the third week of the project, only a quarter of people didn’t have other health conditions. That was based on information from around 600 cancer patients with COVID-19 taking part in the project at the time. Hypertension was seen in a third of participants, followed by diabetes and cardiovascular disease.

COVID-19 affects more patients with metastatic cancer

Almost half of cancer patients with COVID-19 had metastatic cancer, meaning the cancer had spread from its original site to other parts of the body and often places a bigger health burden on patients. Patients with metastatic disease may experience symptoms both of the disease and side effects of medication. So it’s not surprising if they are more susceptible to COVID-19.

Almost 40% of cancer patients with COVID-19 had primary cancer. For a third of these patients, the cancer had started to spread to surrounding tissues, known as locally advanced disease. But the coronavirus infection doesn’t seem to affect people in clinical remission as much. Only 4.4% of participants were on surveillance for cancer and not currently taking cancer treatment.

More than half of cancer patients have mild infection

COVID-19 can range in severity – from asymptomatic infection, when no signs of the illness are present, all the way to severe and critical disease. More than half of cancer patients with COVID-19 had a mild illness. Mild illness can be successfully treated at home. It usually leads to flu-like symptoms, such as mild fever, tiredness, muscle aches, and sometimes cough. However, almost a quarter of cancer patients in the study developed severe illness and a fifth – critical COVID-19, both requiring hospital treatment.

Two thirds of cancer patients survive COVID-19

Project data so far suggests that two thirds of cancer patients survive COVID-19, with the coronavirus leading to death in 30.5% of cancer patients taking part in this study. Now, we need to understand the differences between people who recover from COVID-19 and those who unfortunately do not.

Various factors, such as other health conditions, type and location of cancer and different cancer treatments may all affect the severity and outcome of COVID-19. Only by studying as many infections as possible can we understand these complex relationships and learn who may be more at risk of COVID-19 and what we can do to lower their chances of developing a serious illness.

However, our study may represent a group of patients with more severe COVID-19 infection. It includes patients who have been tested for COVID-19 in line with current policies. Until recently, testing was focussed on patients with symptoms attending hospital.

What we might uncover in future

Soon we will be able to share data about the effect of recent chemotherapy on COVID-19 in cancer patients. We hope that with more reporting centres joining the project, and more people taking part, we will help the cancer community to know how best to treat as many patients as possible.

Please note this data has not been adjusted for co-variates and should be interpreted with caution.