Abstract
Background: People with active cancer are recognised as at risk of COVID-19 complications, but it is unclear whether the much larger population of cancer survivors is at elevated risk. We aimed to address this by comparing cancer survivors and cancer-free controls for (i) prevalence of comorbidities considered risk factors for COVID-19; and (ii) risk of severe influenza, as a marker of susceptibility to severe outcomes from epidemic respiratory viruses. Methods: We included survivors (≥1 year) of the 20 most common cancers, and age, sex and general practice-matched cancer-free controls, derived from English primary care data linked to cancer registrations, hospital admissions and death registrations. Comorbidity prevalences were calculated 1 and 5 years from cancer diagnosis. Risk of hospitalisation or death due to influenza was compared using Cox models adjusted for baseline demographics and comorbidities. Findings: 108,215 cancer survivors and 523,541 cancer-free controls were included. Cancer survivors had more diabetes, asthma, other respiratory, cardiac, neurological, renal, and liver diseases, and less obesity, compared with controls, but there was variation by cancer site. There were 205 influenza hospitalisations/deaths, with cancer survivors at higher risk than controls (adjusted HR 2.78, 95% CI 2.04–3.80). Haematological cancer survivors had large elevated risks persisting for >10 years (HR overall 15.17, 7.84–29.35; HR >10 years from cancer diagnosis 10.06, 2.47–40.93). Survivors of other cancers had evidence of raised risk up to 5 years from cancer diagnosis only (HR >5 years 2.22, 1.31–3.74). Interpretation: Risks of severe COVID-19 outcomes are likely to be elevated in cancer survivors. This should be taken into account in policies targeted at clinical risk groups, and vaccination for both influenza, and, when available, COVID-19, should be encouraged in cancer survivors.
| Original language | English |
|---|---|
| Article number | 100656 |
| Journal | EClinicalMedicine |
| Volume | 29-30 |
| DOIs | |
| Publication status | Published - 17 Dec 2020 |
| Externally published | Yes |
Bibliographical note
Funding Information:This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. The study was approved by the Independent Scientific Advisory Committee (approval number: 20_082). This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The terms of our licence to access the data preclude us from sharing individual patient data with third parties. The raw data may be requested directly from CPRD following their usual procedures. This work was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation; and the Wellcome Trust and the Royal Society (Grant No. 107731/Z/15/Z). KB, HC and HS designed the study. HS and KB created the data set for a previous study. MP and HMcD created code lists to identify immunisations in the primary care data. HC, HS and KB conducted the analyses in the present study. HC and HS wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content. HC, HS and KB are guarantors for this study, had access to all study data and accept full responsibility for the work.
Funding Information:
This work was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation; and the Wellcome Trust and the Royal Society (Grant No. 107731/Z/15/Z ).
Publisher Copyright:
© 2020 The Author(s)
Funding
This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. The study was approved by the Independent Scientific Advisory Committee (approval number: 20_082). This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The terms of our licence to access the data preclude us from sharing individual patient data with third parties. The raw data may be requested directly from CPRD following their usual procedures. This work was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation; and the Wellcome Trust and the Royal Society (Grant No. 107731/Z/15/Z). KB, HC and HS designed the study. HS and KB created the data set for a previous study. MP and HMcD created code lists to identify immunisations in the primary care data. HC, HS and KB conducted the analyses in the present study. HC and HS wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content. HC, HS and KB are guarantors for this study, had access to all study data and accept full responsibility for the work. This work was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation; and the Wellcome Trust and the Royal Society (Grant No. 107731/Z/15/Z ).
ASJC Scopus subject areas
- General Medicine
