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?:abstract
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Background People with active cancer are recognised as at risk of COVID-19 complications, but it is unclear whether the much larger population of cancer survivors is at elevated risk We aimed to address this by comparing cancer survivors and cancer-free controls for (i) prevalence of comorbidities considered risk factors for COVID-19;and (ii) risk of severe influenza, as a marker of susceptibility to severe outcomes from epidemic respiratory viruses Methods We included survivors (≥1 year) of the 20 most common cancers, and age, sex and general practice-matched cancer-free controls, derived from English primary care data linked to cancer registrations, hospital admissions and death registrations Comorbidity prevalences were calculated 1 and 5 years from cancer diagnosis Risk of hospitalisation or death due to influenza was compared using Cox models adjusted for baseline demographics and comorbidities Findings 108,215 cancer survivors and 523,541 cancer-free controls were included Cancer survivors had more diabetes, asthma, other respiratory, cardiac, neurological, renal, and liver diseases, and less obesity, compared with controls, but there was variation by cancer site There were 205 influenza hospitalisations/deaths, with cancer survivors at higher risk than controls (adjusted HR 2 78, 95% CI 2 04–3 80) Haematological cancer survivors had large elevated risks persisting for >10 years (HR overall 15 17, 7 84–29 35;HR >10 years from cancer diagnosis 10 06, 2 47–40 93) Survivors of other cancers had evidence of raised risk up to 5 years from cancer diagnosis only (HR >5 years 2 22, 1 31–3 74) Interpretation Risks of severe COVID-19 outcomes are likely to be elevated in cancer survivors This should be taken into account in policies targeted at clinical risk groups, and vaccination for both influenza, and, when available, COVID-19, should be encouraged in cancer survivors
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