Understanding Covid-19 outcomes in cancer patients: A conversation with the researchers

Dr. Mark Cheng – Cambridge branch President 2021-2022, Founder of SCERC2

Dr. James S. Morris – statistical analyst

Dr. Nihal Sogandji – team member

Dr. José Chen-Xu – team member

1.     Could you tell us about your research project? What was the focus, and what were some of the key findings?

Our research investigated how outcomes from COVID-19 infection varied among cancer patients across different SARS-CoV-2 variants.

Our research involved looking at how outcomes from COVID-19 infection varied among cancer patients relative to the general population and across different variants of SARS-CoV-

We analysed data from 30 studies across 17 countries culminating in a meta-analysis of over 281,000 patients with cancer and nearly 19 million controls to assess the odds of various outcomes from COVID-19 including mortality, hospitalisation and ICU admission. Importantly, we employed a rigorous definition for identifying patients with active cancer and performed subgroup analyses to assess each outcome for the Wu-1, Alpha, Delta, and Omicron variants of SARS-CoV-2, distinguishing our study from data available in literature.

Our main findings were that patients testing positive for SARS CoV-2 were significantly more likely to die if they also had active cancer, compared to COVID-19 patients without cancer, with colorectal, thoracic and metastatic cancers correlated with particularly high odds of mortality. Furthermore, the risk for mortality varied between different SARS-CoV-2 variants, with patients testing positive for the Alpha and Omicron variants found to be at significantly higher risk compared to the earlier (Wu-1) or the Delta variant, a pattern which differs from that observed in the general population.

2. What motivated you to investigate how cancer status affects COVID-19 outcomes? Why was this an important gap to explore, and how did the idea for the project first come together?

Mark: Being part of the original SCERC made me realise how many students across the world are very capable and keen to gain experience in research, and more importantly, make an impact on world policy and decision making via research. Using experience working on SARS-CoV-2 epidemiology, we sought to combine insights from available data on circulating variants of concerns (VOCs) to better understand the complex picture of infection outcomes in high-risk patients.

José: At the start of this project, I was a PhD student seeking to improve my research skills, especially in systematic reviews, while also contributing to improving scientific knowledge.

James: Undertaking previous research projects as an undergraduate allowed me to develop the skills necessary to proficiently analyse large sets of data and extract subtle relationships between variables. However, I had long been looking for a larger project with the potential to affect patient care across specialities to sink my teeth into. So naturally, when I saw the chance to perform the statistical analyses for SCERC2, I jumped at this opportunity. I’m proud to have been a part of this research collaborative both for the impact this has had on our understanding of the epidemiology of the largest pandemic in recent years as well as for the hardworking and professional researchers alongside whom I had the privilege to work.

Nihal: The issue is complex because even though it was clear that patients with cancer are at high risk for adverse outcomes from COVID-19, the evidence base was often fragmented and lacked specificity with regards to cancer status definition, variant specific analysis and vaccination status.

3. What kind of external support, whether from academics, clinicians, or NGOs, helped bring this work to life?

Mark: We are very grateful for Polygeia’s assistance on the initial student outreach. Over 100 very talented student/early-professionals expressed interest, and we recruited a team of 24 from across the world to help our efforts. Academic mentors (listed senior authors oncologist Dr David Favara, statistician Dr Enti Spata, infectious disease expert Prof Ravindra Gupta) were all monumental in fleshing out the initial ideas into the current focused analyses. Finally, our literature search strategy was polished with the help from Ms Isla Kuhn, head of medical library services.

4. Looking ahead, how do you hope your findings will shape global health conversations, particularly around pandemic preparedness, cancer care delivery, or policy development?

Nihal: While the impact of COVID-19 has become less topical, investigating potentially persistent vulnerabilities of patient groups who continue to be at high risk from future variants and pandemics is vital for tailoring public health interventions to meet the needs of high-risk subgroups and promote equity in healthcare delivery.

Our findings of increased ongoing vulnerability of cancer patients have implications for pandemic preparedness in general with questions raised over planning of healthcare delivery including prioritisation of high-risk groups with respect to testing, vaccine delivery and treatment access.

Mark: As this study was a collaboration of oncology domain-knowledge and infectious disease technique-expertise, we hope this study will act as a catalyst for marrying clinical outcomes and sequencing data into research that will guide policy and clinical decision making in future pandemics.

José: This paper provides further insights on the impact of the different variants in health outcomes, reflecting the level of health system preparedness and quality of our healthcare services as well. It is the quality of teaching and continuous education of healthcare professionals, as well as the resources that are available that altogether contribute to how the pandemic played out. These lessons must be learnt so that we can better prepare for future epidemics and pandemics.

5. What advice would you offer to students interested in global health research—especially those hoping to create real-world impact?

Nihal: Publishing in high-impact journals requires strong methodology, persistence and teamwork! I would recommend that students focus on collaborating with others, especially when it comes to global health research – find mentors, organisations like Polygeia which was instrumental in bringing me together with like-minded individuals. Try to look for projects which are both clinically relevant and carry implications for global healthcare practice.

Mark: If you have any idea, go talk to someone! There is no harm in asking, and people are more friendly than you think. Although you will inevitably face rejection, there will always be someone who share similar interests and would help shape the idea if you show willingness to spearhead and champion your own project.

The original concept of SCERC2 was first pitched to an oncology journal as an informal query of interest. We thought it would be a shot in the dark, but we got positive feedback, as well as helpful recommendations for domain experts to act as mentors.

José: Reach out to your university professors and other staff from the different departments; they could potentially include you in research projects, being either basic medicine ones or clinical-oriented. As a doctor working in academia, I believe that these skills are useful to possess, as we must share the knowledge we produced; if we want evidence for improving health services, we must also contribute to developing it, especially if the topic has not been worked on before!

James: Unfortunately, the scoring systems for speciality training applications in the UK has led to a paradigm shift in clinical academia, with many researchers opting to conduct poor quality research that has little impact on patient care. Instead of focusing on quantity of research, I would advise prospective researchers to instead identify an area of medicine which they would be passionate to improve both in terms of the level of theoretic understanding and the quality of patient care. Each study represents the culmination of months to years of work so it is crucial to be passionate about the impact all this effort will have on the people we treat. Each project is an opportunity to further develop different research skills so try your hand at a range of different methodologies with different collaborators until you find the right fit for you.

The research is now available on The Lancet: eClinicalMedicine!

Determinants of SARS-CoV-2 outcomes in patients with cancer vs controls without cancer: a multivariable meta-analysis with genomic imputation

Cheng, Mark T.K.; Morris, J.S. et al.

eClinicalMedicine, Volume 83, 103194

DOI: 10.1016/j.eclinm.2025.103194