UK Coronavirus Cancer Monitoring Project

UK Coronavirus Cancer Monitoring Project

Founded	18 March 2020 (2020-03-18)
Key people	Gary Middleton, Jean-Baptiste Cazier, Rachel Kerr, Lennard Lee
Website	ukcoronaviruscancermonitoring.com

The UK Coronavirus Cancer Monitoring Project or UKCCMP^[1] is a clinician-led reporting project supported to enable tracking of cancer patients who have tested positive for COVID-19 across the United Kingdom.^[2]

The project launched on 26 March 2020^[3] and is one of the first emergency COVID-19 reporting projects in cancer patients in the world. At the time, there was no way of tracking cancer patients with COVID-19 and the interactions of the COVID-19 virus and cancer and cancer treatment was unclear, with limited reporting based on small patient studies.^[4][5] As a result, the reporting project launched as part of the United Kingdom's COVID-19 emergency response. The objective from the project is to identify and learn from every case of COVID-19 in cancer patients through the United Kingdom's 86 cancer centres.^[6]

Support[]

The support from this project came from numerous groups. There was widespread support in the oncology professional communities including the Royal College of Radiologists,^[7] Association of Cancer Physicians^[8] and Action Radiotherapy,^[9] with the Royal College of Radiologists noting that the project was an example of “best practice to benefit oncology patients”. Early academic institutional supporters were the University of Birmingham, University of Oxford and University of Leeds, and patient support groups include Macmillan Cancer Support.^[10][11]

Funding[]

The project was launched in just 100 hours as a result of the pressing urgency of the clinical situation. The initial phases of funding were largely achieved through the donation of time and resources from the supporters and advocates of this project. The University of Birmingham played sizeable role in this process, with the pro-vice-chancellor dedicating the computational and human resources of the University's Centre for Computational Biology, the Institute of Translational Medicine and scientists from the Institute of Cancer and Genomic Sciences.^{[citation needed]}. The project was further boosted by support by Blood Cancer UK in September 2020 with significant investment into automated data analysis platforms at the University of Birmingham.

Organisation[]

Sixty-nine adult cancer care centres participated in UKCCMP. Coronavirus Cancer Reporting was led by a Local Emergency Response Reporting Group at each cancer centre that typically included doctors, nurses and other medical health professionals.^[12] Communication channels were rapidly established between UK cancer centres with local reporting of all COVID-19 presentations.^{[citation needed]} Weekly updates were dispatched to oncologists around the country, achieving close-to-real-time reporting.

The Paediatric UKCCMP signed up all principal treatment centres around the UK treating children with cancer within 3.5 weeks of launch. Real-time data sharing was enabled between the Paediatric UKCCMP and the Children's Cancer and Leukaemia Group, enabling informed decisions to be taken using the latest national dataset.

Impact[]

The project aimed to provide regular data releases to clinicians to provide insight of high clinical utility to inform and facilitate key decision makers^[2] To this end, the project has encouraged a more collaborative approach to patient and clinical management across UK Cancer Centres.^{[citation needed]}

The project was the joint first to recognise that the risk of COVID-19 and chemotherapy was significantly overstated. Previously, UK guidelines has suggested "patients with COVID-19 are at risk of severe disease following systemic anticancer treatment".^[13] The UKCCMP identified that recent chemotherapy use did not significantly increase mortality from COVID-19,^[14] and this was subsequently confirmed by a US cancer COVID-19 registry ^[15] and a French breast cancer registry.^[16] A survey completed in January 2021 showed that 90% of individuals who were involved in the UKCCMP email and bulletin distribution list had changed their prescribing habits based on the findings from the UKCCMP. Globally, all major cancer professional organisations now support the uninterrupted delivery of cancer care to individuals with cancer, except in the very highest risk settings.^[17][18]

The UKCCMP was also the first to perform an analysis by cancer subtype identifying that blood cancer patients were at significantly increased risk.^[19] This observations enabled groups advocating for blood cancer suffers to enter the United Kingdom's "clinically vulnerable" COVID-19 list enabling access to additional payments and support. The study also found that risk was lowest in patients with breast cancer and ovarian/cervical cancers, and highest in those with prostate cancer. This effect was largely driven by the protective nature of being female and the risk factor of being of increasing age.^[20]

The UKCCMP was one of the first groups to flag the major issue of poor access to ITU for individuals with cancer during the early phases of the pandemic in 2020.^[21] Subsequent UK studies have confirmed dispelled the myth that cancer patients do significantly worse when admitted to ITU and therefore should not be given access.^[22] This has led to significantly higher admissions amongst the cancer population to ITU.^[23]

The paediatric UKCCMP cohort also made pivotal insights noting that in children who developed a SARS-CoV-2 infection, having a diagnosis of cancer did not put that at increased risk. This was an extremely reassuring finding that enabled the paediatric cancer community to continue the uninterrupted delivery of anti-cancer treatments globally in the confidence that they were not putting children at risk.^[24] This finding also enabled children in the United Kingdom to be removed from the clinically extremely vulnerable shielding group, enabling children with cancer to continue to mix with their peer group and continue their normal activities.

A number of smaller projects were also initiated as a result of this project, all aimed at promoting the safety of cancer patients during the pandemic. This included the UK Birmingham Chemotherapy cancer COVID-19 project which analysed the utility of testing every patient on chemotherapy for COVID-19 using PCR nasopharyngeal swab screening.^[25]

Case numbers[]

The first recorded cases of COVID-19 in cancer patients started in March 2020. Numbers were initially slow, but by April 2020, number of cancer patients with COVID-19 reached their peak, with over 300 cases were being recorded each week. As a result of data from this project and NHS guidance about the delivery of cancer care during the pandemic,^[26] widespread changes to cancer care was implemented to reduce risk to cancer patients. The number of COVID-19 in cancer patients decreased during June and July and in the entire month of August, only one case of a cancer patient with COVID-19 was recorded.^{[citation needed]}

Project structure[]

The UK Coronavirus cancer monitoring project is a clinician-led reporting project which depends on the time and skills of the oncology community in the United Kingdom. The project was conceived on 18 March 2020 and launched on 26 March 2020 with support from the University of Birmingham and several oncology organisations within the United Kingdom.^[3][11] The project team is chaired by Professor Gary Middleton, Professor Jean-Baptiste Cazier, Professor Rachel Kerr and Dr Lennard Lee, and is composed of academic and clinical teams led by the scientific board for data acquisition, analysis and dissemination. The project management team consists of researchers from all major UK cancer centres including King's College London, University of Leeds, University of Edinburgh, the Clatterbridge Cancer Centre, and University College London.^[27]

References[]