A study by Lee and others published in the BMJ Health & Care Informatics 2021 looked into this issue and concluded an increased risk of fatality for patients with COVID-19 plus haematological malignancies and demonstrated similar findings of COVID-19 on melanoma, uterine and kidney cancer patients.  

The study sought to understand COVID-19’s imposed increased risk of fatality whilst controlling for covariates, such as age, sex, metastasis status and cancer type.  

The authors conducted survival analyses of 4,606 cancer patients with COVID-19 test results from 16th March to 11th October 2020 in the UK Biobank.  They estimated the overall fatality with and without COVID-19 infection.  

The authors found that COVID-19 results in an overall higher risk of fatality of 7.76 that is 95% by following 4,606 patients with cancer for 21 days after the test.  

The higher risk varied amongst cancer type with over a tenfold increase in fatality rate for melanoma, haematological malignancies, uterine cancer and kidney cancer. 

Although COVID-19 imposed a higher risk for localised versus distant metastasis cancer, those with distant metastases yielded higher overall fatality rates due to their multiplicative effects.  

In localised cancers or haematological malignancies, timely cancer diagnosis and treatment is critical for increasing patient survival.  Otherwise, local cancers may progress into distant metastases, while distant metastases may become uncontrollable, both of which results in more fatalities.  

However, with COVID-19 evidently impacting cancer care, diagnosis and treatment delays are inevitable due to the unavailability of medical resources, potential exposed risk of COVID-19 in medical facilities and complications of treatment.  

Attention is therefore important in the timeliness of therapy for patients with cancer and must be encouraged to minimise the risk of fatality.  

However, prior to this study, the extensive risk that delays in cancer therapies add for persons with COVID-19 was not known.  

This study demonstrated that COVID-19 added a tenfold more risk to 21 day fatality rates for patients with melanoma, lymphoma, leukaemia, uterine and kidney cancer with a positive COVID-19 infection versus no COVID-19 infection.  

Fortunately, the study suggested that COVID-19 did not impose a larger risk to distant metastasised cancers as compared with localised cancers in general.  

However, the overall fatality rates in distant metastases were still about twice that of localised cancers due to the multiplicative effects. 

It should be noted that fatality rates were dependent on cancer type and COVID-19 did impose larger risk to distant metastasis of some types of cancer such as melanoma, prostate cancer and ovarian cancer.  

In all cases higher rates of fatality amongst patients with COVID-19 of older age were consistent with the literature. 

The authors concluded that the importance of timely treatment of COVID-19 amongst older cancer patients with localised cancers was imperative. 

Timely care is especially important for those with haematological malignancies, melanoma, uterine or kidney cancers due to the notable additional risk of fatality from COVID-19 infection.  The added risk of metastases due to the delay of therapies, leads to an even higher likelihood of fatality because of the multiplicative effects of risk.  

The authors suggest there should be a change in COVID-19 vaccine strategy with haematological malignancies in particular because the benefit of vaccination far outweighed its risks of side effects. 

The London General Practice, the leading London doctors’ clinic has remained open during the whole of the pandemic and has enhanced its screening programmes in order to provide an effective early screening diagnosis for many types of cancer and other diseases.  

It encourages those who wish to be screened to undertake and offers an initial video consultation to elucidate what investigations are necessary.

Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed

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