Background
Patients with coronavirus disease 2019 (COVID-19) who have underlying malignancy have a higher mortality rate compared with those without cancer, although the magnitude of such excess risk is not clearly defined. We performed a systematic review and pooled analysis to provide precise estimates of the mortality rate among patients with both cancer and COVID-19.
Methods
A systematic literature search involving peer-reviewed publications, preprints and conference proceedings up to July 16, 2020, was performed. The primary end-point was the case fatality rate (CFR), defined as the rate of death among patients with cancer and COVID-19. The CFR was assessed with a random effects model, which was used to derive a pooled CFR and its 95% confidence interval (CI).
Results
Fifty-two studies, involving a total of 18,650 patients with both COVID-19 and cancer, were selected for the pooled analysis. A total of 4243 deaths were recorded in this population. The probability of death was 25.6% (95% CI: 22.0%–29.5%; I2 = 48.9%) in this patient population.
Conclusions
Patients with cancer who develop COVID-19 have high probability of mortality. Appropriate and aggressive preventive measures must be taken to reduce the risk of COVID-19 in patients with cancer and to optimally manage those who do contract the infection.
The COVID-19 pandemic has had a major impact on patients with cancer, including a sharp reduction in cancer screening and the postponement of ongoing or planned therapy during the initial months of the pandemic, which could result in excess deaths from cancer in the future. To restart standard cancer treatment protocols, it is important to quantify the risk of mortality among patients with both cancer and COVID-19, and data generated by large registries such as CCC-19 and Thoracic cancERs international coVid 19 cOLlaboraTion could be valuable in this regard. Meta-analyses are also a useful tool to aggregate smaller data sets and estimate mortality risks in this vulnerable population.
The results of our pooled analysis clearly show that the mortality is high among patients with cancer and COVID-19 and should be considered as an independent risk factor, in addition to older age, male sex, black race, current smoker, other comorbidities and so on. As more data become available, it is becoming increasingly clear that within the population of patients with both cancer and COVID-19, there are subsets with greater risk, such as patients with haematological malignancies or lung cancer, which need deeper analysis.
Conclusions
Patients with cancer who develop COVID-19 have high probability of mortality. Appropriate and aggressive preventive measures must be taken to reduce the risk of infection with SARS-CoV-2 in patients with cancer and to optimally manage those who do contract the infection.
Reference & source information: https://www.ejcancer.com/
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