Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital

SIMPLE SUMMARY: Cancer patients may have increased risk from COVID-19 due to impaired fitness and immunosuppression secondary to underlying cancer and the effects of anti-cancer treatments. We previously demonstrated that solid cancer and anti-cancer treatments may be associated with increased death following COVID-19 in an analysis of patients treated in our London hospital during the first wave of the COVID-19 pandemic (March to May 2020). The United Kingdom experienced a second peak of COVID-19 hospitalizations during December 2020 to February 2021. We aimed to compare the outcomes between patients with solid cancer presenting to our hospital during the first and second peaks of the COVID-19 pandemic and to determine if cancer and anti-cancer treatments were still risk factors for death. We found lower overall deaths in our hospital during the second peak. Metastatic cancer and anti-cancer treatments were risk factors for worse outcomes following COVID-19 in patients with cancer. ABSTRACT: An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.