COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

Lennard Yw Lee, Jean-Baptiste Cazier, Vasileios Angelis, Roland Arnold, Vartika Bisht, Naomi A Campton, Julia Chackathayil, Vinton Wt Cheng, Helen M Curley, Matthew W Fittall, Luke Freeman-Mills, Spyridon Gennatas, Anshita Goel, Simon Hartley, Daniel J Hughes, David Kerr, Alvin Jx Lee, Rebecca J Lee, Sophie E McGrath, Christopher P MiddletonNirupa Murugaesu, Thomas Newsom-Davis, Alicia Fc Okines, Anna C Olsson-Brown, Claire Palles, Yi Pan, Ruth Pettengell, Thomas Powles, Emily A Protheroe, Karin Purshouse, Archana Sharma-Oates, Shivan Sivakumar, Ashley J Smith, Thomas Starkey, Chris D Turnbull, Csilla Várnai, Nadia Yousaf, Rachel Kerr, Gary Middleton, Piangfan Naksukpaiboon, Laura Feeney, UK Coronavirus Monitoring Project Team

Research output: Contribution to journalArticlepeer-review

854 Citations (Scopus)


BACKGROUND: Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.

METHODS: In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.

FINDINGS: From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56-10·02]; p<0·0001), being male (1·67 [1·19-2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36-2·80]; p<0·001) and cardiovascular disease (2·32 [1·47-3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81-1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.

INTERPRETATION: Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.

FUNDING: University of Birmingham, University of Oxford.

Original languageEnglish
Pages (from-to)1919-1926
Number of pages8
JournalThe Lancet
Issue number10241
Early online date28 May 2020
Publication statusPublished - 20 Jun 2020

Bibliographical note

This publication was done under the collaboration with the team at the University of Birmingham under the UK coronavirus cancer monitoring project team (


  • Age Factors
  • Aged
  • Antineoplastic Agents/therapeutic use
  • Betacoronavirus
  • COVID-19
  • Cause of Death
  • Comorbidity
  • Coronavirus Infections/complications
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms/complications
  • Pandemics
  • Pneumonia, Viral/complications
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Sex Factors


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