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Meta-Analysis
. 2021 Aug:7:1286-1305.
doi: 10.1200/GO.21.00072.

Mortality in Cancer Patients With COVID-19 Who Are Admitted to an ICU or Who Have Severe COVID-19: A Systematic Review and Meta-Analysis

Amogh Rajeev Nadkarni  1 , Swapna C Vijayakumaran  1 , Sudeep Gupta  2 , Jigeeshu V Divatia  1
Affiliations
Meta-Analysis

Mortality in Cancer Patients With COVID-19 Who Are Admitted to an ICU or Who Have Severe COVID-19: A Systematic Review and Meta-Analysis

Amogh Rajeev Nadkarni et al. JCO Glob Oncol. 2021 Aug.

Abstract

Purpose: There are scarce data to aid in prognostication of the outcome of critically ill cancer patients with COVID-19. In this systematic review and meta-analysis, we investigated the mortality of critically ill cancer patients with COVID-19.

Methods: We searched online databases and manually searched for studies in English that reported on outcomes of adult cancer patients with COVID-19 admitted to an intensive care unit (ICU) or those with severe COVID-19 between December 2019 and October 2020. Risk of bias was assessed by the Modified Newcastle-Ottawa Scale. The primary outcome was all-cause mortality. We also determined the odds of death for cancer patients versus noncancer patients, as also outcomes by cancer subtypes, presence of recent anticancer therapy, and presence of one or more comorbidities. Random-effects modeling was used.

Results: In 28 studies (1,276 patients), pooled mortality in cancer patients with COVID-19 admitted to an ICU was 60.2% (95% CI, 53.6 to 6.7; I2 = 80.27%), with four studies (7,259 patients) showing higher odds of dying in cancer versus noncancer patients (odds ratio 1.924; 95% CI, 1.596 to 2.320). In four studies (106 patients) of patients with cancer and severe COVID-19, pooled mortality was 59.4% (95% CI, -39.4 to 77.5; I2 = 72.28%); in one study, presence of hematologic malignancy was associated with significantly higher mortality compared with nonhematologic cancers (odds ratio 1.878; 95% CI, 1.171 to 3.012). Risk of bias was low.

Conclusion: Most studies were reported before the results of trials suggesting the benefit of dexamethasone and tocilizumab, potentially overestimating mortality. The observed mortality of 60% in cancer patients with COVID-19 admitted to the ICU is not prohibitively high, and admission to the ICU should be considered for selected patients (registered with PROSPERO, CRD42020207209).

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Conflict of interest statement

Sudeep GuptaResearch Funding: Roche, Sanofi, Johnson & Johnson, Amgen, Celltrion, Oncostem Diagnostics, Novartis, AstraZeneca, Intas Jigeeshu V. DivatiaStock and Other Ownership Interests: Cipla, Zydus CadillaOther: Lecture fees from Edwards India, paid to my institution, outside the published workNo other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
PRISMA chart listing included and excluded studies. ICU, intensive care unit; MERS-COV, Middle East respiratory syndrome coronavirus; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
FIG 2
FIG 2
Schematic representation of primary and secondary outcomes analyzed. ICU, intensive care unit.
FIG 3
FIG 3
Meta-analysis, including subgroup analysis on geographical location.
FIG A1
FIG A1
Funnel plot for assessing publication bias. Cancer patients with COVID-19 admitted to the ICU (x-axis) versus ICU mortality rate (y-axis); reports studies within and beyond ±3 SD of pooled proportion of ICU mortality. ICU, intensive care unit; SD, standard deviation.
FIG A2
FIG A2
Meta-regression for proportion of patients who died in the intensive care unit (on the x-axis) versus date of recruitment. (on the y-axis). The circles indicate the proportion of patients dying in each study. The circle size is proportional to the precision of the estimate.
FIG A3
FIG A3
Meta-analysis of cancer patients with severe COVID-19.
See this image and copyright information in PMC

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