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Meta-Analysis
. 2021 Mar;33(3):e180-e191.
doi: 10.1016/j.clon.2020.11.006. Epub 2020 Nov 19.

Clinical Characteristics and Outcomes in Patients with COVID-19 and Cancer: a Systematic Review and Meta-analysis

P Zarifkar  1 , A Kamath  2 , C Robinson  2 , N Morgulchik  3 , S F H Shah  4 , T K M Cheng  4 , C Dominic  5 , A O Fehintola  6 , G Bhalla  5 , T Ahillan  7 , L Mourgue d'Algue  8 , J Lee  9 , A Pareek  10 , M Carey  11 , D J Hughes  12 , M Miller  11 , V K Woodcock  13 , M Shrotri  14
Affiliations
Meta-Analysis

Clinical Characteristics and Outcomes in Patients with COVID-19 and Cancer: a Systematic Review and Meta-analysis

P Zarifkar et al. Clin Oncol (R Coll Radiol). 2021 Mar.

Abstract

Much of routine cancer care has been disrupted due to the perceived susceptibility to SARS-CoV-2 infection in cancer patients. Here, we systematically review the current evidence base pertaining to the prevalence, presentation and outcome of COVID-19 in cancer patients, in order to inform policy and practice going forwards. A keyword-structured systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 in cancer patients. Studies were critically appraised using the NIH National Heart, Lung and Blood Institute's quality assessment tool set. The pooled prevalence of cancer as a co-morbidity in patients with COVID-19 and pooled in-hospital mortality risk of COVID-19 in cancer patients were derived by random-effects meta-analyses. In total, 110 studies from 10 countries were included. The pooled prevalence of cancer as a co-morbidity in hospitalised patients with COVID-19 was 2.6% (95% confidence interval 1.8%, 3.5%, I2: 92.0%). Specifically, 1.7% (95% confidence interval 1.3%, 2.3%, I2: 57.6.%) in China and 5.6% (95% confidence interval 4.5%, 6.7%, I2: 82.3%) in Western countries. Patients most commonly presented with non-specific symptoms of fever, dyspnoea and chest tightness in addition to decreased arterial oxygen saturation, ground glass opacities on computer tomography and non-specific changes in inflammatory markers. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%, I2: 52.3%). We identified impeding questions that need to be answered to provide the foundation for an iterative review of the developing evidence base, and inform policy and practice going forwards. Analyses of the available data corroborate an unfavourable outcome of hospitalised patients with COVID-19 and cancer. Our findings encourage future studies to report detailed social, demographic and clinical characteristics of cancer patients, including performance status, primary cancer type and stage, as well as a history of anti-cancer therapeutic interventions.

Keywords: COVID-19; Cancer; SARS-CoV-2; mortality; prevalence; systematic review.

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Figures

Fig 1
Fig 1
Flowchart of included and excluded studies. Eighty cohort studies, six cross-sectional studies, two case-control studies, one interventional trial, 10 case series and 11 case reports were included.
Fig 2
Fig 2
Proportion of hospitalised COVID-19 patients with cancer. The pooled prevalence of active cancer in hospitalised patients with COVID-19 across 37 cohort studies was 2.6% (95% confidence interval 1.8%, 3.5%). In China and Western countries, the prevalence figures were 1.7% (95% confidence interval 1.3%, 2.3%) and 5.6% (95% confidence interval 4.5%, 6.7%), respectively.
Fig 3
Fig 3
Proportion of deaths among hospitalised patients with cancer and COVID-19. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%).
Fig 4
Fig 4
Recommendations for future studies of COVID-19 in cancer patients.
See this image and copyright information in PMC

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