CCP Cancer UK Companion Study
CCP Cancer UK Companion Study
Currently, there is extremely limited information regarding the risks posed by SARS-CoV-2 to
 patients with cancer. This study aims to understand the presentation, management and outcomes
 of patients with cancer. The influence of cancer type and treatment will be explored as well
 as comparing cancer patients with non-cancer patients. This dataset, on robust analysis, will
 provide valuable information that would educate as well as help inform practice for future
 possible outbreaks. The information may also inform the development of guidelines with regard
 to the care and management of cancer patients with viruses such as COVID19 and similar
 infectious diseases. Cancer is immunosuppressive, the nature of the immunosuppression seems
 to be influenced by the microbiota, and in addition pulmonary infections
In December 2019 the first pneumonia cases of unknown origin were identified in Wuhan, the
 capital city of Hubei province. High-throughput sequencing revealed the pathogen to be a
 novel enveloped RNA betacoronavirus. Initially named 2019 novel coronavirus (2019-nCoV) it
 was subsequently renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (2).
 Transmission of SARS-CoV-2 is via respiratory droplets and direct contact, and infection
 results in coronavirus disease (COVID-19). The World Health Organization (WHO) has recently
 declared the SARS-CoV-2 outbreak a public health emergency of international concern on 30th
 January 2020, and a global pandemic on 11th March 2020.

 The clinical characteristics of COVID-19 are typically fever, dry cough and fatigue,
 sometimes accompanied by sore throat, chest discomfort and difficulty breathing. However, a
 wide range of other symptoms are possible, including gastrointestinal symptoms such as
 nausea, vomiting, loss of appetite, abdominal pain and diarrhoea. Loss of taste and smell
 have also been described.

 Individuals with malignant disease are more prone to respiratory viruses than individuals
 without cancer as a result of immunosuppression caused by either the underlying disease
 process or systemic anti-cancer therapy. The death rate from influenza in patients with solid
 organ tumours is much higher than expected for the background population, even allowing for
 likely ascertainment bias. This is reflected in individuals with cancer being recommended to
 receive the seasonal flu vaccination. Certain groups of cancer patients are even more prone
 to infection. For example, patients with haematological malignancy undergoing bone marrow
 transplantation have significant mortality even with rhinovirus, which can double the
 transplant related mortality. There is currently no prospective robust data regarding the
 presentation, management and outcome of patients with COVID-19 with cancer who are
 immunocompromised as result of either the disease or treatment. Furthermore, it is not clear
 if the immunosuppressive effects of systemic anti-cancer therapy such as chemotherapy are the
 same across all cancer types and the possible risks entailed by targeted therapies and
 immunotherapy. Currently, cancer patients on treatment are considered at high risk group of
 possible severe infection with SARS-CoV-2 and measures such as self-isolation are being
 recommended to mitigate the risks of such patients being infected. However, information to
 inform this decision, and whether any specific sub-groups of patients are at particular risk
 is lacking. These data are vital to inform policy on cancer treatments as patients may be
 potentially exposed to SARS-CoV-2 for a long time to come. Furthermore, given patients with
 cancer are often immunosuppressed and this may alter the clinical presentation as well as
 clinical course and outcomes. Different tumour types may also have implications for
 SARS-CoV-2 exposure, for example patients with lung cancer may be more susceptible, and
 require different pathways to ensure care can be delivered safely. This protocol aims to
 describe the presentation, management and outcomes of patients with solid and haematological
 malignancies with COVID-19 and compared to non-cancer patients. The CCP-CANCER UK will
 provide valuable information that would educate as well as help inform current practice and
 development of guidelines globally with regard to COVID19 infection in cancer patients. While
 samples collected within CCP-UK from cancer patients will enable an understanding of the
 biology of COVID-19 in the setting of cancer-related immunodeficiency both innate and
 iatrogenic.
Inclusion Criteria:

 - Patients with proven COVID-19 and a diagnosis of cancer who are enrolled into any Tier of
 the Principal CCP-UK protocol.

 Exclusion Criteria:

 - None in addition to those specified in the Principal CCP-UK protocol.