A study by Geraldes published in The Lancet April 22nd 2021 looks at the fact that there is a higher fatality rate from COVID-19 in patients with cancer in the United Kingdom than in Europe. 

The study echoed concerns expressed by oncologists early in the COVID-19 pandemic.  

This study led by researchers from Imperial College London reported that the survival of patients with cancer after infection with SARS-CoV-2 seems to be disparate between the United Kingdom and countries in continental Europe with apparently a more detrimental outcome for patients in the United Kingdom compared with their European counterparts.  

In the retrospective study, David Pinato and colleagues analyse the risk of death from all causes at 30 days and 6 months following a diagnosis of COVID-19, in 468 patients with cancer from the United Kingdom and 924 patients with cancer from Italy, Spain, France, Belgium and Germany.  

The data was obtained from the On COVID study database, which is a European registry of patients with cancer who were consecutively diagnosed with COVID-19 in 27 centres between February and September 2020.  

Notably, compared with the continental Europe cohort, the UK cohort had a lower proportion of patients with breast cancer, 12.39% versus 23.7% and a higher proportion of patients with a gynaecological or genitourinary cancer, 31.2% versus 14.29%.  

Even after adjusting for key clinical pathological factors, including age, comorbidities and tumour stage and status (although the authors noted that their analyses could be affected by unmeasured bias such as SARS-CoV-2 viral load), patients in the UK had a significantly higher case fatality rate at 30 days after a COVID-19 diagnosis than those in Europe, 40.38% versus 26.5%.  

This difference in case fatality rate persisted at six months after a COVID-19 diagnosis, 47.64% in the United Kingdom versus 33.33% in Europe. 

Similarly, the risk of death at 30 days after a COVID-19 diagnosis was 1.52 times higher in the United Kingdom versus Europe.  

The authors also reported that United Kingdom patients diagnosed with COVID-19 were less likely to be receiving either COVID-19 specific therapies, for example corticosteroids or antiviral drugs or to have received active anti-cancer treatment within the previous four weeks compared with those in Europe.  

In analyses, exposure to any COVID-19 treatment was associated with a reduced risk of death at both 30 days and at 6 months, whereas receipt of anticancer therapy exerted a protective effect on the risk of death at the 6 month time point only.  

The study author Mieke Van Hemelrijck told Lancet Oncology that this highlighted the need to carefully continue cancer screening, diagnosis and treatment during the pandemic.  

The author suggested that UK patients were less likely to receive any kind of anti-COVID treatment including drugs like hydroxychloroquine, that has now approved ineffective and others like steroids, anti-interleukin-6 and Remdesivir, which have shown benefit on disease severity.  

However, the author concluded it was worth pointing out that the European cohort of this study was enriched for patients with breast cancer who were overall the ones showing a decreased risk of death.  

The authors concluded by stressing the importance of vaccinating and giving anti-COVID therapy to infected patients with cancer.  

They also felt that the efforts of the vaccination campaign in the United Kingdom might revert this imbalance, especially as the number of vaccinated in the citizens in the United Kingdom has so far vastly exceeded those of any other European country. 

The London General Practice commends the government on its vaccination programme and encourages those who are called for vaccination to undertake it.

Dr Paul Ettlinger

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