A Systematic Review and Meta-Analysis of Cancer Patients Affected by a Novel Coronavirus

Abstract

Background: Cancer patients with coronavirus disease 2019 (COVID-19) have been reported to have double the case fatality rate of the general population.

Methods: A systematic search of PubMed, Embase, and Cochrane Central was done for studies on cancer patients with COVID-19. Pooled proportions were calculated for categorical variables. Odds ratio (OR) and forest plots (random-effects model) were constructed for both primary and secondary outcomes.

Results: This systematic review of 38 studies and meta-analysis of 181 323 patients from 26 studies included 23 736 cancer patients. Our meta-analysis shows that cancer patients with COVID-19 have a higher likelihood of death (n = 165 980, OR = 2.54, 95% confidence interval [CI] = 1.47 to 4.42), which was largely driven by mortality among patients in China. Cancer patients were more likely to be intubated. Among cancer subtypes, the mortality was highest in hematological malignancies (n = 878, OR = 2.39, 95% CI = 1.17 to 4.87) followed by lung cancer (n = 646, OR = 1.83, 95% CI = 1.00 to 3.37). 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 comorbidities. There was insufficient data to assess the association of COVID-19-directed therapy and survival outcomes in cancer patients.

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.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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. A) Forest plot of pooled in-hospital all-cause mortality rates between cancer patients and noncancer patients. B) Forest plot of intensive care unit admission rates between cancer patients and noncancer patients. C) Forest plot of intubation rates between cancer patients and noncancer patients. D) Forest plot of severe disease between active cancer patients and cancer survivors. Odds ratio calculated using the Mantel-Haenszel random-effects model and P value from the z test to examine whether the pooled estimate of effect is statistically significant. CI = confidence interval; M-H = Mantel-Haenszel Test.

Figure 3.

Mortality outcomes in cancer subtypes with COVID-19. A) Forest plot of pooled in-hospital all-cause mortality rates between hematological cancer patients and nonhematological cancer patients. B) Forest plot of pooled in-hospital all-cause mortality rates between lung cancer patients and nonlung cancer patients. C) Forest plot of pooled in-hospital all-cause mortality rates between gastrointestinal cancer patients and nongastrointestinal cancer patients. D) Forest plot of in-hospital all-cause mortality rates between breast cancer patients and nonbreast cancer patients. Odds ratio calculated using the Mantel-Haenszel random-effects model and P value from the z test to examine whether the pooled estimate of effect is statistically significant. CI = confidence interval; M-H = Mantel-Haenszel Test.

Figure 4.

Mortality outcomes with different types of cancer-directed treatment with COVID-19. A) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving chemotherapy vs other modalities. B) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving radiotherapy vs other modalities. C) Forest plot of pooled in-hospital all-cause mortality rates between patients receiving immunotherapy vs other modalities. D) 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 and P value from the z test to examine whether the pooled estimate of effect is statistically significant. CI = confidence interval; M-H = Mantel-Haenszel Test.