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

Abstract

Background: Since the beginning of the SARS-Cov2 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, I20.0%, 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 two-fold 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-Cov2 infection in patients with cancer. Funding: No external funding was obtained.

The impact of cancer on the severity of disease in patients affected with COVID-19: an umbrella review and meta-meta-analysis of systematic reviews and meta-analyses involving 1,064,476 participants

“…The number of research and participants of the studies included in the meta-meta-analysis is as follows: a total of 58 studies and 709,908 participants were included in the meta-analysis performed by Arayici et al [ 16 ], a total of 81 primary research and 61,532 individuals were included in the meta-analysis performed by Khoury et al [ 17 ], a total of 35 studies and 142,355 participants were included in the meta-analysis performed by Di Felice et al [ 18 ], a total of 57 papers and 63,413 participants were included in the meta-analysis performed by Han et al [ 20 ], a total of 26 studies and 181,323 participants were included in the meta-analysis performed by Venkatesulu et al [ 21 ], a total of 19 studies and 63,019 individuals were included in the meta-analysis performed by Yang et al [ 22 ], a total of 13 papers and 3,775 participants were included in the meta-analysis performed by Salunke et al [ 24 ], a total of 38 primary research and 7,094 participants were included in the meta-analysis performed by Tian et al [ 23 ], a total of 32 research and 46,499 participants were included in the meta-analysis performed by Giannakoulis et al [ 19 ], and a total of 14 papers and 29,900 participants were included in the meta-analysis performed by Parohan et al [ 25 ].…”

“…A total of five systematic reviews and meta-analyses [ 16 , 18 , 19 , 21 , 24 ] assessed the association between COVID-19 and ICU admission for cancer patients. The pooled ES which was calculated for ICU admission was significantly increased in cancer patients affected by COVID-19 (OR = 1.84, %95 CI: 1.44–2.34, p < 0.001) (Fig.…”

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…In a recent meta-analysis conducted by Di Felice et al, it was found that infected patients with cancer have a twofold higher risk of experiencing a severe form of the COVID-19 illness as well as ICU admission compared to non-cancer patients. The association of SARS-CoV-2 infection with mortality in patients with malignancies was stronger in studies from Asia than from those of North America and Europe ( Di Felice et al, 2022 ). In our region, studies on COVID-19 patients with cancer are scarce and include only a small number of subjects.…”

Vitamin D3 for reducing mortality from cancer and other outcomes before, during and beyond the COVID‐19 pandemic: A plea for harvesting low‐hanging fruit

“…A recent meta‐analysis has demonstrated that cancer patients are at more than a 2‐fold increased risk of adverse outcomes of COVID‐19 infections (severe course of the disease, intensive care unit admission and mortality) [ 20 ]. A potential positive impact of vitamin D 3 supplementation on those outcomes could therefore be of particularly high relevance for cancer patients, especially in the light of additional adverse outcomes of the pandemic on cancer care, such as delayed diagnosis and treatment.…”