A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19

Abstract

Background The COVID-19 pandemic hit all over the world and cancer patients are more vulnerable for COVID-19. Mortality rate may increase up to 25% in solid malignancies. In parallel to increased mortality rates among cancer patients, safety concerns regarding cancer treatment has increased over time. However, there were contradictory results for the cancer treatment during pandemic. In this study, we assessed the effect of cancer treatment on the severity of COVID-19. Methods The MEDLINE database was searched on September 01, 2020. Primary endpoints were severe disease and death in the cancer patients treated within the last 30 days before COVID-19 diagnosis. Quality of included studies were assessed by New Castle-Ottawa Scale. Generic inverse variance method was used to calculate odds ratios (ORs) for each outcome. Results Sixteen studies were included for this meta-analysis. Chemotherapy within the last thirty days before COVID-19 diagnosis increased the risk of death in cancer patients after adjusting for confounding variables (OR: 1.85; 95% CI:1.26-2.71). However, severe COVID-19 risk did not increase. Furthermore, targeted therapies, immunotherapy, surgery, and radiotherapy did not increase the severe disease and death risk in cancer patients with COVID-19. Conclusion Chemotherapy increased the risk of death from COVID-19 in cancer patients. However, there was no safety concern for immunotherapy, targeted therapies, surgery, and radiotherapy.

Differences in mortality of cancer patients with COVID-19 in a Brazilian cancer center

“…A systematic review revealed that patients undergoing cancer treatment, such as chemotherapy, had a higher risk of death from COVID-19 [18] , which aligns with our own findings that patients who had received chemotherapy in the previous 30 days were more vulnerable to death from COVID-19. However, another systematic review found no association between the receipt of any type of cancer therapy and mortality from SARS-CoV-2 [14] .…”

“…Epidemiological and clinical evidence points to a greater risk of serious outcomes of COVID-19 in elderly patients, men, smokers, and patients with comorbidities such as hypertension, diabetes, obesity, and cancer [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] [See Text Box and Table 1 ]. Cancer patients are more vulnerable to complications and death when infected with SARS-CoV-2.…”

“… Rate of adverse events lower in a time-matched population of patients with cancer without COVID-19 Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes Patients with active hematologic or lung malignancies, peri-COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Yekedüz et al [18] 16 studies included in a meta-analysis drawn from a MEDLINE database searched on September 01, 2020 with primary endpoints of severe disease and death in cancer patients treated within the last 30 d before COVID-19 diagnosis Chemotherapy within 30 d before COVID-19 diagnosis increased risk of death in cancer patients after adjusting for confounding variables (OR, 1.85; 95%CI, 1.26–2.71); but not risk of ever COVID disease Targeted therapies, immunotherapy, surgery and radiotherapy did not increase the severe disease and death risk in cancer patients with COVID-19 Chemotherapy increased risk of death from COVID-19 in cancer patients, There was no safety concern for immunotherapy, targeted therapies, surgery and radiotherapy. Elkrief et al [19] 252 patients (N = 249 adult and N = 3 pediatric) patients with cancer and diagnosis of COVID-19 prospectively identified between March 3 and May 23, 2020 in the provinces of Quebec and British Columbia in Canada.…”

Epidemiology and clinical course of severe acute respiratory syndrome coronavirus 2 infection in cancer patients in the Veneto Oncology Network: The Rete Oncologica Veneta covID19 study

“… 9 A recent meta-analysis including 16 studies concluded for an increased risk of death for chemotherapy administered within the last 30 days before COVID-19 diagnosis. 29 …”

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

“…The effect of the pandemic is disproportionate, the most affected being the countries with health systems that will become overburdened, with the risk of exacerbating socioeconomic inequalities. There is a consensus on the protection of patients and medical staff, the use of telemedicine services is recommended in the departments involved in the treatment of head and neck cancers, and an individualized decision should be taken after assessment of the benefit and risk of treatment, whether it is surgical followed by adjuvant treatment, or definitive radio-chemotherapy [9][10][11].…”