A systematic review and meta-analysis of cancer patients affected by a novel coronavirus

Abstract

Background: Cancer patients with COVID-19 disease have been reported to have double the case fatality rate of the general population.

Materials and methods: A systematic search of PubMed/MEDLINE, Embase, Cochrane Central, Google Scholar, and MedRxiv was done for studies on cancer patients with COVID-19. Pooled proportions were calculated for categorical variables. Odds ratio and forest plots were constructed for both primary and secondary outcomes. The random-effects model was used to account for heterogeneity between studies.

Results: This systematic review of 31 studies and meta-analysis of 181,323 patients from 26 studies involving 23,736 cancer patients is the largest meta-analysis to the best of our knowledge assessing outcomes in cancer patients affected by COVID-19. Our meta-analysis shows that cancer patients with COVID-19 have a higher likelihood of death (odds ratio, OR 2.54), which was largely driven by mortality among patients in China. Cancer patients were more likely to be intubated, although ICU admission rates were not statistically significant. Among cancer subtypes, the mortality was highest in hematological malignancies (OR 2.43) followed by lung cancer (OR 1.8). There was no association between receipt of a particular type of oncologic therapy and mortality. Our study showed that cancer patients affected by COVID-19 are a decade older than the normal population and have a higher proportion of co-morbidities. There was insufficient data to assess the association of COVID-directed therapy and survival outcomes in cancer patients. Despite the heterogeneity of studies and inconsistencies in reported variables and outcomes, these data could guide clinical practice and oncologic care during this unprecedented global health pandemic.

Conclusion: Cancer patients with COVID-19 disease are at increased risk of mortality and morbidity. A more nuanced understanding of the interaction between cancer-directed therapies and COVID-19-directed therapies is needed. This will require uniform prospective recording of data, possibly in multi-institutional registry databases.

Keywords: COVID-19; cancer; chemotherapy; meta-analysis; radiotherapy.

Figure 1:

PRISMA flow diagram of the selection of studies to be included in the systematic review and meta-analysis

Figure 2:

Prognosis of patients with COVID-19 1 A) Forest plot of pooled in-hospital all-cause mortality rates between cancer patients and non-cancer patients.1B) Forest plot of ICU admission rates between cancer patients and non-cancer patients.1C) Forest plot of intubation rates between cancer patients and non-cancer patients.1D) Forest plot of severe disease between active cancer patients and cancer survivors. Odds ratio calculated using the Mantel-Haenszel random-effects model.

Figure 3:

Mortality outcomes in cancer subtypes with COVID-19 1 A) Forest plot of pooled in-hospital all-cause mortality rates between hematological cancer patients and non-hematological cancer patients.1B) Forest plot of pooled in-hospital all-cause mortality rates between lung cancer patients and non-lung cancer patients 1C) Forest plot of pooled in-hospital all-cause mortality rates between gastrointestinal cancer patients and non- gastrointestinal cancer patients.1D) Forest plot of in-hospital all-cause mortality rates between breast cancer patients and non-breast cancer patients .Odds ratio calculated using the Mantel-Haenszel random-effects model.

Figure 4:

Mortality outcomes with different types of treatment with COVID-19 1 A) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving chemotherapy vs. other modalities 1B) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving radiotherapy vs. other modalities 1C) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving immunotherapy vs. other modalities 1D) Forest plot of pooled-in hospital all-cause mortality rates between patients receiving targeted therapies vs. other modalities. Odds ratio calculated using the Mantel-Haenszel random-effects model.