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The risk of contracting SARS-CoV-2 or developing COVID-19 for people with cancer: a systematic review of the early evidence

The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia. Directorate General for Health, Lombardy Region, Milano, Italy; Environmental Health Unit, Agency for Health Protection, Pavia, Italy. Department of Anaesthesia/Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Nigeria. University of Melbourne, Centre for Cancer Research and Centre for Health Policy, Australia; Department of Cancer Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, New York. Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon France. Institute Cancer Policy, King's College London, United Kingdom. Institute Cancer Policy, King's College London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Cancer Control Research, BC Cancer, Canada; Faculty of Health Sciences, Simon Fraser University, Canada. Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada. Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada; Department of Oncology and Department of Public Health Sciences, Queen's University, Kingston, ON, Canada. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia. Electronic address: karen.canfell@nswcc.org.au. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia. Electronic address: julia.steinberg@nswcc.org.au.

Journal of cancer policy. 2022;:100338
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PICO Summary

Population

People with cancer (12 studies, n= >24 million).

Intervention

Systematic review assessing early evidence of the risk of contracting SARS-CoV-2 or developing COVID-19.

Comparison

Outcome

All four studies of COVID-19 incidence (including 24,181,727 individuals, 125,649 with pre-existing cancer) reported that people with cancer had higher COVID-19 incidence rates. Eight studies reported SARS-CoV-2 test positivity for >472,000 individuals, 48,370 with pre-existing cancer. Seven of these studies comparing people with any and without cancer, were pooled using random effects [pooled odds ratio 0.91, unadjusted for age, sex, or comorbidities]. Two studies suggested people with active or haematological cancer had lower risk of a positive test. All 12 studies had high risk of bias; none included universal or random COVID-19/SARS-CoV-2 testing.
Abstract
BACKGROUND The early COVID-19 literature suggested that people with cancer may be more likely to be infected with SARS-CoV-2 or develop COVID-19 than people without cancer, due to increased health services contact and/or immunocompromise. While some studies were criticised due to small patient numbers and methodological limitations, they created or reinforced concerns of clinicians and people with cancer. These risks are also important in COVID-19 vaccine prioritisation decisions. We performed a systematic review to critically assess and summarise the early literature. METHODS AND FINDINGS We conducted a systematic search of Medline/Embase/BioRxiv/MedRxiv/SSRN databases including peer-reviewed journal articles, letters/commentaries, and non-peer-reviewed pre-print articles for 1 January-1 July 2020. The primary endpoints were diagnosis of COVID-19 and positive SARS-CoV-2 test. We assessed risk of bias using a tool adapted from the Newcastle-Ottawa Scale. Twelve studies were included in the quantitative synthesis. All four studies of COVID-19 incidence (including 24,181,727 individuals, 125,649 with pre-existing cancer) reported that people with cancer had higher COVID-19 incidence rates. Eight studies reported SARS-CoV-2 test positivity for >472,000 individuals, 48,370 with pre-existing cancer. Seven of these studies comparing people with any and without cancer, were pooled using random effects [pooled odds ratio 0.91, 95%CI:0.57-1.47; unadjusted for age, sex, or comorbidities]. Two studies suggested people with active or haematological cancer had lower risk of a positive test. All 12 studies had high risk of bias; none included universal or random COVID-19/SARS-CoV-2 testing. CONCLUSIONS The early literature on susceptibility to SARS-CoV-2/COVID-19 for people with cancer is characterised by pervasive biases and limited data. To provide high-quality evidence to inform decision-making, studies of risk of SARS-CoV-2/COVID-19 for people with cancer should control for other potential modifiers of infection risk, including age, sex, comorbidities, exposure to the virus, protective measures taken, and vaccination, in addition to stratifying analyses by cancer type, stage at diagnosis, and treatment received.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine