Scottish COVID CAncer iMmunity Prevalence (SCCAMP) - a longitudinal study of patients with cancer receiving active anti-cancer treatment during the COVID-19 pandemic

Abstract

Background

Cancer and systemic anti-cancer treatment (SACT) have been identified as possible risk factors for infection and related severe illness associated with SARS-CoV-2 virus as a consequence of immune suppression. The Scottish COVID CAncer iMmunity Prevalence (SCCAMP) study aims to characterise the incidence and outcomes of SARS-Cov-2 infection in patients undergoing active anti-cancer treatment during the COVID-19 pandemic and their antibody response following vaccination.

Patients and Methods

Eligible patients were those attending secondary care for active anti-cancer treatment for a solid tumour. Blood samples were taken for total SARS-CoV-2 antibody assay (Siemens) at baseline and after 1.5, 3, 6 and 12 months. Data on COVID-19 infection, vaccination, cancer type, treatment and outcome was obtained from routine electronic health records.

Results

The study recruited 766 eligible participants between 28th May 2020 and 31st October 2021. The median age was 62.7 years, and 66.5% were female. Most received cytotoxic chemotherapy (79%), with the remaining 14% receiving immunotherapy and 7% receiving another form of anti-cancer therapy (radiotherapy, other systemic anti-cancer treatment). 48 (6.3%) tested positive for SARS-CoV-2 by PCR during the study period. The overall infection rate matched that of the age-matched local general population until May 2021, after which population levels appeared higher. Antibody testing detected additional evidence of infection prior to vaccination, taking the total number to 58 (7.6%). There was no significant difference in SARS-CoV-2 PCR positive test rates based on type of anti-cancer treatment. Mortality proportion was similar between those who died within 90 days of a positive SARS-CoV-2 PCR and those with no positive PCR (10.4% vs 10.6%). Death from all causes was lowest among vaccinated patients, and of the patients who had a positive SARS-CoV-2 PCR at any time, all of those who died during the study period were unvaccinated. Multivariate analysis correcting for age, gender, socioeconomic status, comorbidities and number of previous medications revealed that vaccination was associated with a significantly lower infection rate regardless of treatment with chemotherapy or immunotherapy with hazard ratios of 0.307 (95% CI 0.144-0.6548) or 0.314 (95% CI 0.041-2.367) in vaccinated patients respectively. Where antibody data was available, 96.3% of patients successfully raised SARS-CoV-2 antibodies at a time point after vaccination. This was unaffected by treatment type.

Conclusion

SCCAMP provides real-world evidence that patients with cancer undergoing SACT have a high antibody response and protection from SARS-CoV-2 infection following COVID-19 vaccination.

Highlights

The SCCAMP dataset represents the largest longitudinal study of patients with cancer undergoing anti-cancer treatment during the COVID-19 pandemic

Rates of infection in the cancer cohort mirrored those of the local age adjusted population

Vaccination was effective in patients with cancer undergoing active treatment in terms of antibody response and SARS-CoV-2 PCR rates

Treatment type did not impact the rate of SARS-CoV-2 antibody response

SciScore for 10.1101/2022.02.22.22271041: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	IRB: Consent was provided when attending for anti-cancer treatment (ACT), primarily SACT, at the Edinburgh Cancer Centre (ECC) either at the Western General Hospital (WGH), Edinburgh or St John’s Hospital (SJH), Livingston (NHS Lothian NRS BioResource, BioBank SR1418, NHS Research Ethics Committee (REC): 20/ES/0061 and SCCAMP, NHS Research Ethics Committee (REC) REC: 20/SS/0109). Consent: Blood samples were taken for antibody testing at consent up to a maximum of five collections up to 1 year from consent (approx. +42 days, +84 days, +6 months, +1 year), when returning for further routine out-patient care.
Sex as a biological variable	A multivariate model investigating the risk of catching COVID-19 during the study was defined as the length of time free from infection with respect to recruitment (day) with patients without a COVID-19 positive PCR censored and the following variable binary groupings applied: Age > 60, gender = female, high socioeconomic score = SMID quintiles 4 & 5, High medication comorbidity > 5 prescribed medications in 1 year prior to recruitment, QCI score > 0 in 5 years prior to recruitment, cancer treatment class (chemotherapy, immunotherapy and other) as a binary yes/no events, vaccinated = 2 or more doses.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.

Table 2: Resources

Antibodies
Sentences	Resources
Serum samples were tested via the validated Siemens Total (IgG/M and IgA) SARS-Cov-2 antibody assay at Ninewells Hospital, NHS Tayside (17,18).	SARS-Cov-2 suggested: None

Results from OddPub: Thank you for sharing your data.

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

We note some limitations of SCCAMP. Our study has not evaluated specific aspects of the immune response, including T-cell response or quantitative, longitudinal assessment of different antibody classes. This may reveal a differential in the longevity or robustness of the immune response to SARS-CoV-2 in patients treated with SACT. As regular asymptomatic PCR screening was not routine clinical practice during the studied period of time, we acknowledge that asymptomatic cases, particularly in the post-vaccination time period, will likely be underestimated. However, broadly we can still presume that our results are reflective of symptomatic infection, and our comments regarding COVID-19 PCR test results should be interpreted accordingly. In addition to this, as noted where relevant in this analysis, the number of patients with a positive SARS-CoV-2 PCR were relatively small, and consequently have been cautious in over-analysing sub-categories of this group in our cohort. Our real-world follow-up strategy inevitably results in not all patients providing all or as many samples for antibody testing. This is also reflective of the need to balance between exposing patients to contact only when needed and the dynamic research changes demanded by the waves of SARS-CoV-2 infection. Our study relies on publicly available and published data to provide control data for a non-cancer population, and although patients on other treatments not thought to significantly impact on the immune syste...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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