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Meta-Analysis
. 2024 Apr 15;154(8):1394-1412.
doi: 10.1002/ijc.34798. Epub 2023 Dec 11.

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis

Julia Steinberg  1 , Suzanne Hughes  1 , Harriet Hui  1 , Matthew J Allsop  2 , Sam Egger  1 , Michael David  1   3 , Michael Caruana  1 , Peter Coxeter  1 , Chelsea Carle  1 , Tonia Onyeka  4   5 , Isabel Rewais  1 , Maria J Monroy Iglesias  6 , Nuria Vives  7   8 , Feixue Wei  9 , Derrick Bary Abila  10 , Giulia Carreras  11 , Marilina Santero  12 , Emma L O'Dowd  13 , Gigi Lui  1 , Musliu Adetola Tolani  14 , Maeve Mullooly  15 , Shing Fung Lee  16   17 , Rebecca Landy  18 , Sharon J B Hanley  19   20 , Gemma Binefa  21   22 , Charlene M McShane  23 , Muluken Gizaw  24   25   26 , Poongulali Selvamuthu  27 , Houda Boukheris  28   29 , Annet Nakaganda  30 , Isil Ergin  31 , Fabio Ynoe Moraes  32 , Nahari Timilshina  33 , Ashutosh Kumar  34 , Diama B Vale  35 , Ana Molina-Barceló  36 , Lisa M Force  37   38 , Denise Joan Campbell  1 , Yuqing Wang  39 , Fang Wan  39 , Anna-Lisa Baker  39 , Ramnik Singh  39 , Rehana Abdus Salam  1 , Susan Yuill  1   39 , Richa Shah  40 , Iris Lansdorp-Vogelaar  41 , Aasim Yusuf  42 , Ajay Aggarwal  43   44 , Raul Murillo  45   46 , Julie S Torode  47   48 , Erich V Kliewer  49 , Freddie Bray  40 , Kelvin K W Chan  50   51 , Stuart Peacock  49   51   52 , Timothy P Hanna  53   54 , Ophira Ginsburg  55 , Mieke Van Hemelrijck  6 , Richard Sullivan  47 , Felipe Roitberg  56   57   58 , André M Ilbawi  57 , Isabelle Soerjomataram  40 , Karen Canfell  1
Affiliations
Meta-Analysis

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis

Julia Steinberg et al. Int J Cancer. .

Abstract

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Keywords: COVID-19; cancer; death; meta-analysis; systematic review.

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Conflict of interest statement

Conflict of Interests

Prof. Karen Canfell reports she is co-PI, and A/Prof Michael Caruana reports that he is an investigator, of an investigator-initiated trial of cervical screening, “Compass”, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. The ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics. Prof. Canfell is also co-PI on a major implementation program “Elimination of Cervical Cancer in the Western Pacific” which receives support from the Minderoo Foundation and equipment donations from Cepheid Inc. Dr Fabio Ynoe de Moraes reports a previous consulting fee from Câncer em Foco; he also reports honoraria from AstraZeneca and IASLC, both outside of the current work. Dr Lisa M. Force reports funding from the Bill and Melinda Gates Foundation, Conquer Cancer Foundation, St. Jude Children’s Research Hospital, and the NIH Loan Repayment Program; these are disclosed for transparency and not believed to bias her contributions to this work.

Other authors declare no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram based on the PRISMA 2020 flow chart summarising the article screening process.
Figure 2.
Figure 2.. Risk of COVID-19-related death by time since cancer diagnosis or treatment.
A) Any/solid cancers B) Within-study comparisons, any/solid cancers C) Haematological cancers * Studies of hospital inpatients with COVID-19. D: years since diagnosis. T: years since treatment. DT: years since diagnosis or treatment. NR: not reported. aHR: adjusted hazard ratio. aOR: adjusted odds ratio. aRR: adjusted rate ratio. CI: confidence interval.
Figure 3.
Figure 3.. Meta-regression for risk of COVID-19-related death by time since cancer diagnosis or treatment.
A) Any/solid cancers B) Within-study comparisons, any/solid cancers C) Haematological cancers D) Overview of meta-regression estimates * Studies of hospital inpatients with COVID-19. D: years since diagnosis. T: years since treatment. DT: years since diagnosis or treatment. NR: not reported. aHR: adjusted hazard ratio. aOR: adjusted odds ratio. aRR: adjusted rate ratio. CI: confidence interval. n/â: not applicable, lower limit of 95%CI is <1 for all fitted values.
See this image and copyright information in PMC

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