Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal 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: julia.steinberg@nswcc.org.au. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia. Electronic address: karen.canfell@nswcc.org.au.

Journal of cancer policy. 2022;:100340
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Abstract
BACKGROUND Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. METHODS AND FINDINGS We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8,000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59-4.20, adjusted OR=1.37,95%CI:1.16-1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33-2.08; five studies, adjusted HR=1.19,95%CI:1.02-1.38). CONCLUSIONS The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis. DATA AVAILABILITY All the original data of this study were available upon reasonable request to the corresponding authors (KC or JS).
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine