Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome.

BACKGROUND: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS: In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.

Does clinical trial participation improve outcomes in patients with ovarian cancer?

INTRODUCTION: Treatment on a clinical trial is considered to be beneficial to oncology patients. However, supportive evidence for this is scarce. Trial effect describes the phenomenon of improved health outcomes in patients treated with standard of care (SOC) on trial compared to those receiving SOC outside of a clinical trial. We evaluated trial effect in patients with ovarian cancer treated at our tertiary cancer centre. METHODS: We performed a retrospective cohort study of patients with ovarian cancer treated at The Christie National Health Service Foundation Trust. Patients treated on one of three first-line clinical trials: (SCOTROC-4, ICON-5, ICON-7) were matched (for age, International Federation of Gynaecology and Obstetrics stage, surgical status and performance status) with individuals receiving the same SOC off trial. Survival was calculated using Kaplan-Meier methodology. RESULTS: 60 patients were evaluated; 30 on trial and 30 on SOC off trial. The median progression-free survival (PFS) was 21.8 months (control group) and 25.9 months (trial group), median overall survival (OS) was 64.3 months (control group) and 68.9 months (trial group). There was no difference in PFS (log-rank test: HR 0.87 (95% CI 0.48 to 1.54), p=0.6) or OS (log-rank test: HR 0.87 (95% CI 0.46 to 1.64), p=0.7) between groups. CONCLUSIONS: Patient survival was similar regardless if treated on trial or as SOC. Our findings do not support trial effect, at least in a tertiary cancer centre. Clinical trial participation in specialised cancer centres promotes best practice to the benefit of all patients. These findings may impact discussions round consent of patients to trials and organisation of oncology services.

Current action for skin cancer risk reduction in English schools: a report on a survey carried out for the Department of Health.

The objective of this study was to identify current action for skin cancer risk reduction in English schools and thus set a baseline for future skin cancer risk reduction interventions. A postal questionnaire survey was sent to 1295 primary, 59 middle and 216 secondary school headteachers, a 10% sample of schools in England in 1998. Since the Health Education Authority/Department of Health/British Association of Dermatologists introduced the Sun Awareness Guidelines for Schools in 1995, seven items from the Guidelines, i.e. education, uniform, shade, outdoor activities, sunscreens, staff awareness, and parent and governor alliances were chosen as outcome measures. The results of the survey showed that most schools had taken at least one of the seven actions (mean 2.67, SD 0.88). Of the schools which addressed sun protection, the majority started to do so after the release of the Sun Awareness Guidelines in 1995. Judging from the length of time schools had been covering sun awareness issues, the proportion of schools which were just beginning to implement sun protection in 1995 was greater than those who began in the previous year. Teaching in the curriculum was the most frequent action taken, but the approach used was usually information giving. Brimmed hats and long sleeves were rarely part of summer school wear. Most schools had less than 25% of their outdoor break areas in shade, but action was being taken to increase this. Sports days were usually scheduled for the afternoon. Sunscreen use was allowed in over 80% of schools, but its application presented teachers with a dilemma. Few staff manuals contained sun awareness issues; few staff had attended in-service courses on the subject; two-thirds of headteachers would support their staff attending them. Few schools had developed parent and governor alliances. We conclude that help is needed for schools in the form of materials, courses, funds and clear Government policy if their action is to play a major role in reducing the incidence of skin cancer.