Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK.
Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK.
Eur J Cancer. 2020 Sep;136:99-106. doi: 10.1016/j.ejca.2020.06.027. Epub 2020 Jul 7.
In light of the coronavirus disease 2019 (COVID-19) pandemic, cancer centres in the United Kingdom and Europe re-organised their services at an unprecedented pace, and many patients with cancer have had their treatments severely disrupted. Patients with cancer were considered at high risk on sparse evidence, and despite a small number of emerging observational studies, the true incidence and impact of COVID-19 in the 'at-risk' population of patients with cancer is yet to be defined.
Epidemiological and clinical data were collected prospectively for patients attending the Royal Marsden Hospital and three network hospitals between March 1st and April 30th 2020 that were confirmed to have Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Significance of clinical and pathological characteristics was assessed using the Fisher's exact test and Wilcoxon rank sum test, whilst univariate and multivariate logistic regression models were used to further assess risk. The number of patients attending in March/April 2020 for face-to-face attendances was also extracted.
During the 2-month study period, 867 of 13,489 (6.4%) patients met the criteria leading to swab testing. Of the total at-risk population, only 113 of 13,489 (0.84%) were swab positive, 101 of 13,489 (0.75%) required hospital admission and 29 of 13,489 (0.21%) died of COVID-19. Of the patients that attended the hospital to receive cytotoxic chemotherapy alone or in combination with other therapy, 59 of 2001 (2.9%) were admitted to the hospital for COVID-19-related issues and 20 of 2001 (1%) died. Of the patients that collected targeted treatments, 16 of 1126 (1.4%) were admitted and 1 of 1126 (0.1%) died. Of the 11 patients that had received radiotherapy, 6 of 1042 (0.6%) required inpatient admission and 2 of 1042 (0.2%) died.
Administration of systemic anticancer therapy appears to be associated with a modest risk of severe COVID-19 infection. Based on this snapshot taken as the first wave of COVID-19 hit our practice, we conclude that continuation of active cancer treatment, even in the palliative setting, is appropriate.
由于 2019 年冠状病毒病（COVID-19）大流行，英国和欧洲的癌症中心以前所未有的速度重新组织服务，许多癌症患者的治疗受到严重干扰。基于有限的证据，癌症患者被认为属于高危人群，尽管有一些新出现的观察性研究，但 COVID-19 在癌症高危人群中的真实发病率和影响仍有待确定。
前瞻性收集 2020 年 3 月 1 日至 4 月 30 日期间在皇家马斯登医院和三个网络医院就诊并经确认患有严重急性呼吸综合征冠状病毒 2（SARS-CoV2）感染的患者的流行病学和临床数据。使用 Fisher 确切检验和 Wilcoxon 秩和检验评估临床和病理特征的意义，同时使用单变量和多变量逻辑回归模型进一步评估风险。还提取了 2020 年 3 月/4 月期间因面对面就诊而就诊的患者人数。
在 2 个月的研究期间，13489 名患者中有 867 名符合进行拭子检测的标准。在高危人群中，13489 人中仅有 113 人拭子检测呈阳性，13489 人中 101 人需要住院治疗，13489 人中 29 人死于 COVID-19。在因接受细胞毒性化疗或联合其他治疗而到医院就诊的患者中，59 例（2001 例中的 2.9%）因 COVID-19 相关问题住院，20 例（2001 例中的 1%）死亡。在接受靶向治疗的患者中，16 例（1126 例中的 1.4%）住院，1 例（1126 例中的 0.1%）死亡。在接受放射治疗的 11 名患者中，6 例（1042 例中的 0.6%）需要住院治疗，2 例（1042 例中的 0.2%）死亡。
给予全身抗癌治疗似乎与严重 COVID-19 感染的风险适度增加相关。根据 COVID-19 首次袭击我们治疗时的快照，我们得出结论，即使在姑息治疗环境下，继续进行积极的癌症治疗也是合适的。
