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Meta-Analysis
. 2022 Feb 16:11:e74634.
doi: 10.7554/eLife.74634.

Effect of cancer on outcome of COVID-19 patients: a systematic review and meta-analysis of studies of unvaccinated patients

Giulia Di Felice  1   2 , Giovanni Visci  1   2 , Federica Teglia  1 , Marco Angelini  1 , Paolo Boffetta  1   3
Affiliations
Meta-Analysis

Effect of cancer on outcome of COVID-19 patients: a systematic review and meta-analysis of studies of unvaccinated patients

Giulia Di Felice et al. Elife. .

Abstract

Background: Since the beginning of the SARS-CoV-2 pandemic, cancer patients affected by COVID-19 have been reported to experience poor prognosis; however, a detailed quantification of the effect of cancer on outcome of unvaccinated COVID-19 patients has not been performed.

Methods: To carry out a systematic review of the studies comparing the outcome of unvaccinated COVID-19 patients with and without cancer, a search string was devised which was used to identify relevant publications in PubMed up to December 31, 2020. We selected three outcomes: mortality, access to ICU, and COVID-19 severity or hospitalization. We considered results for all cancers combined as well as for specific cancers. We conducted random-effects meta-analyses of the results, overall and after stratification by region. We also performed sensitivity analyses according to quality score and assessed publication bias.

Results: For all cancer combined, the pooled odds ratio (OR) for mortality was 2.32 (95% confidence interval [CI] 1.82-2.94, I2 for heterogeneity 90.1%, 24 studies), that for ICU admission was 2.39 (95% CI 1.90-3.02, I2 0.0%, 5 studies), that for disease severity or hospitalization was 2.08 (95% CI 1.60-2.72, I2 92.1%, 15 studies). The pooled mortality OR for hematologic neoplasms was 2.14 (95% CI 1.87-2.44, I2 20.8%, 8 studies). Data were insufficient to perform a meta-analysis for other cancers. In the mortality meta-analysis for all cancers, the pooled OR was higher for studies conducted in Asia than studies conducted in Europe or North America. There was no evidence of publication bias.

Conclusions: Our meta-analysis indicates a twofold increased risk of adverse outcomes (mortality, ICU admission, and severity of COVID-19) in unvaccinated COVID-19 patients with cancer compared to COVID-19 patients without cancer. These results should be compared with studies conducted in vaccinated patients; nonetheless, they argue for special effort to prevent SARS-CoV-2 infection in patients with cancer.

Funding: No external funding was obtained.

Keywords: COVID-19; SARS-CoV-2; cancer; cancer biology; disease severity; epidemiology; global health; human; meta-analysis; mortality.

PubMed Disclaimer

Conflict of interest statement

GD, GV, FT, MA, PB No competing interests declared

Figures

Figure 1.
Figure 1.. Flowchart for the identification of articles for the meta-analyses (PRISMA).
Figure 2.
Figure 2.. Forest plot – all types of cancer – outcome 1.
Figure 3.
Figure 3.. Forest plot – all types of cancer – outcome 2.
Figure 4.
Figure 4.. Forest plot – all types of cancer – outcome 3 or 4.
Figure 5.
Figure 5.. Funnel plot of Egger’s test to assess publication bias – all types of cancer – outcome 1.
Figure 6.
Figure 6.. Forest plot – all types of cancer – outcome 1 – reported versus calculated OR.
Figure 7.
Figure 7.. Forest plot – hematological neoplasms – outcome 1.
Figure 7—figure supplement 1.
Figure 7—figure supplement 1.. Forest plot – hematological neoplasms – outcome 2, 3, or 4.
See this image and copyright information in PMC

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