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Pinato, David J.; Scotti, Lorenza; Gennari, Alessandra; Colomba-Blameble, Emeline; Dolly, Saoirse; Loizidou, Angela; Chester, John; Mukherjee, Uma; Zambelli, Alberto; Aguilar-Company, Juan; Bower, Mark; Galazi, Myria; Salazar, Ramon; Bertuzzi, Alexia; Brunet, Joan; Mesia, Ricard; Sita-Lumsden, Ailsa; Colomba, Johann; Pommeret, Fanny; Segui, Elia; Biello, Federica; Generali, Daniele; Grisanti, Salvatore; Rizzo, Gianpiero; Libertini, Michela; Moss, Charlotte; Evans, Joanne S.; Russell, Beth; Wuerstlein, Rachel; Vincenzi, Bruno; Bertulli, Rossella; Ottaviani, Diego; Linan, Raquel; Marrari, Andrea; Carmona-Garcia, M. C.; Sng, Christopher. C. T.; Tondini, Carlo; Mirallas, Oriol; Tovazzi, Valeria; Fotia, Vittoria; Cruz, Claudia A.; Saoudi-Gonzalez, Nadia; Felip, Eudald; Lloveras, Ariadna R.; Lee, Alvin. J. X.; Newsom-Davis, Thomas; Sharkey, Rachel; Chung, Chris; Garcia-Illescas, David; Reyes, Roxana; Wong, Yien N. Sophia; Ferrante, Daniela; Marco-Hernandez, Javier; Ruiz-Camps, Isabel; Gaidano, Gianluca; Patriarca, Andrea; Sureda, Anna; Martinez-Vila, Clara; de Torre, Ana Sanchez; Rimassa, Lorenza; Chiudinelli, Lorenzo; Franchi, Michela; Krengli, Marco; Santoro, Armando; Prat, Aleix; Tabernero, Josep; Hemelrijck, Mieke V.; Diamantis, Nikolaos and Cortellini, Alessio (2021): Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study. In: European Journal of Cancer, Vol. 150: pp. 190-202

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Background: Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU. Methods: We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UKand EU cohorts and evaluated the association of these factors with the risk of adverse out-comes in multivariable Cox regression models Findings: Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (haz-ard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%;p < 0.0001;HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and inter leukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, indepen-dent of the patient's age, gender, tumour stage and status;number of comorbidities;COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessa-tion of anticancer therapy after COVID-19 were similar in the UK and EU cohorts. Interpretation: UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anti-cancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted. (C) 2021 Elsevier Ltd. All rights reserved.

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