Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta‐analysis of cohort studies

Abstract

Background Heterogeneous evidence exists on the effect of coronavirus disease 2019 (COVID‐19) on the clinical outcomes of patients with cancer. Methods A systematic review was performed using the Medline, Embase, and CENTRAL databases and the World Health Organization Novel Coronavirus website to identify studies that reported mortality and characteristics of patients with cancer who were diagnosed with COVID‐19. The primary study outcome was mortality, defined as all‐cause mortality or in‐hospital mortality within 30 days of initial COVID‐19 diagnosis. The pooled proportion of mortality was estimated using a random‐effects model, and study‐level moderators of heterogeneity were assessed through subgroup analysis and metaregression. Results Among 2922 patients from 13 primarily inpatient studies of individuals with COVID‐19 and cancer, the pooled 30‐day mortality rate was 30% (95% CI, 25%‐35%). The overall pooled 30‐day mortality rate among 624 patients from 5 studies that included a mixture of inpatient and outpatient populations was 15% (95% CI, 9%‐22%). Among the hospitalized studies, the heterogeneity (I2 statistic) of the meta‐analysis remained high (I2, 82%). Cancer subtype (hematologic vs solid), older age, male sex, and recent active cancer therapy each partially explained the heterogeneity of mortality reporting. In multivariable metaregression, male sex, along with an interaction between the median patient age and recent active cancer therapy, explained most of the between‐study heterogeneity (R2, 96%). Conclusions Pooled mortality estimates for hospitalized patients with cancer and COVID‐19 remain high at 30%, with significant heterogeneity across studies. Dedicated community‐based studies are needed in the future to help assess overall COVID‐19 mortality among the broader population of patients with cancer.

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials

“…Patients participating in clinical trials often have progressive advanced-stage cancer, are undergoing active treatment and usually make several visits to clinics and hospitals for study-related procedures, which potentially increases their exposure to SARS-CoV-2 infection at multiple points. Thus, prioritization for vaccination is imperative, particularly considering that patients with cancer also seem to have an increased risk of severe COVID-19 and complications and mortality from the disease [7][8][9][10][11][12][13][14] . Due consideration should also be given to other well-recognized risk factors for severe COVID-19, such as advanced age (≥65 years), comorbidities (for example, chronic pulmonary, cardiovascular or renal disease) and other sociodemographic factors (such as overcrowded housing, single-parent households and ethnicity) 29 , when prioritizing patients with cancer for vaccination, with priority given to those at most risk.…”

“…Multiple studies have revealed that patients with cancer have an increased risk of complications and mortality from COVID-19, including 30-day mortality of 30% in hospitalized patients with COVID-19 and cancer compared with 21% in those without cancer [7][8][9][10][11][12][13][14] . Given the greater severity of the disease and higher risk of death, patients with cancer are considered a high-priority subgroup for COVID-19 vaccination.…”

Update Breast Cancer 2021 Part 1 – Prevention and Early Stages

“…According to the known current evidence, mortality rates for cancer patients with concomitant COVID-19 are significantly higher than in the general COVID-19 population, and are associated with increased age, male gender and prior conditions [92,93]. The mortality rates published so far vary widely [94 -96].…”

“…Currently, mortality rates of cancer patients with COVID-19 are much higher at 25-30 % [92,93]. A meta-analysis of cohort studies of mortality in patients hospitalised for cancer and COVID-19 found a pooled 30-day mortality rate of 30 % (95 % CI: 25-35 %), with a rate of 26% (95% CI: 22-31 %) for the subgroup with solid tumours [93]. However, it should be noted that meta-analysis included mostly inpatient cases and that the cohorts came from different health care systems.…”

“…gar nicht durchgeführt werden konnten[86]. Die Fachgesellschaften DGHO (Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie e. V.), ESMO, ASCO (American Society of Clinical Oncology) und andere haben Leitlinien und Empfehlungen zur Betreuung und Priorisierung von Brustkrebs behandelnden Maßnahmen für die Zeit der COVID-Pandemie entwickelt[87 -91].Die Mortalitätsraten für Krebspatienten mit COVID-19 ist nach der bekannten, aktuellen Sachlage deutlich erhöht gegenüber der allgemeinen COVID-19-Population und wird mit erhöhtem Alter, männlichem Geschlecht und Vorerkrankungen assoziiert[92,93]. Publizierte Mortalitätsraten wiesen eine hohe Variation auf [94 -96].…”