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

Aakash Desai, Rohit Gupta, Shailesh Advani, Lara Ouellette, Nicole M Kuderer, Gary H Lyman, Ang Li, Aakash Desai, Rohit Gupta, Shailesh Advani, Lara Ouellette, Nicole M Kuderer, Gary H Lyman, Ang Li

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.

Keywords: cancer; coronavirus disease 2019 (COVID-19); malignancy; mortality; novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

© 2020 American Cancer Society.

References

    1. World Health Organisation (WHO). Coronavirus disease (COVID-19) outbreak webpage. Accessed March 15, 2020.
    1. World Health Organization. Coronavirus Disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update. Accessed August 22, 2020.
    1. Desai A, Sachdeva S, Parekh T, Desai R. COVID-19 and cancer: lessons from a pooled meta-analysis. JCO Glob Oncol. 2020;6:557-559.
    1. Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020;31:894-901.
    1. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335-337.
    1. Venkatesulu BP, Chandrasekar VT, Girdhar P, et al. A systematic review and meta-analysis of cancer patients affected by a novel coronavirus. medRxiv. Published online May 29, 2020. doi:10.1101/2020.05.20115303
    1. ElGohary GM, Hashmi S, Styczynski J, et al. The risk and prognosis of COVID-19 infection in cancer patients: a systematic review and meta-analysis. Hematol Oncol Stem Cell Ther. Published online July 30, 2020. doi:10.1016/j.hemonc.2020.07.005
    1. Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: a systematic review of current evidence. Crit Rev Oncol Hematol. 2020;150:102972.
    1. Bauchner H, Golub RM, Zylke J. Editorial concern-possible reporting of the same patients with COVID-19 in different reports. JAMA. 2020;323:1256.
    1. Desai A, Warner J, Kuderer N, et al. Crowdsourcing a crisis response for COVID-19 in oncology. Nat Cancer. 2020;1:473-476.
    1. Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395:1907-1018.
    1. Lee LY, Cazier JB, Starkey T, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020;395:1919-1926.
    1. World Health Organization. COVID-19: Global literature on coronavirus disease. Accessed August 22, 2020.
    1. Desai A, Gupta R, Li A, Kuderer N, Lyman G.COVID-19 and cancer: a risk factor and outcomes meta-analysis. Accessed August 22, 2020.
    1. Covidence. Covidence systematic review software. Covidence; 2020. Accessed August 22, 2020.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items forsystematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
    1. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
    1. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.
    1. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72:39.
    1. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857-872.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
    1. Freeman MF, Tukey JW. Transformations related to the angular and the square root. Ann Math Stat. 1950;21:607-611.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-560.
    1. Aries JA, Davies JK, Auer RL, et al. Clinical outcome of coronavirus disease 2019 in haemato-oncology patients. Br J Haematol. 2020;190:e64-e67.
    1. Cook G, Ashcroft AJ, Pratt G, et al. Real-world assessment of the clinical impact of symptomatic infection with severe acute respiratory syndrome coronavirus (COVID-19 disease) in patients with multiple myeloma receiving systemic anti-cancer therapy. Br J Haematol. 2020;190:e83-e86.
    1. Dai M, Liu D, Liu M, et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. 2020;10:783-791.
    1. Fattizzo B, Giannotta JA, Sciume M, et al. Reply to “COVID-19 in persons with haematological cancers”: a focus on myeloid neoplasms and risk factors for mortality. Leukemia. 2020;34:1957-1960.
    1. Rivera DR, Peters S, Panagiotou OA, et al. Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: a COVID-19 and Cancer Consortium (CCC19) cohort study. Cancer Discov. 2020;10:1514-1527.
    1. Martin-Moro F, Marquet J, Piris M, et al. Survival study of hospitalised patients with concurrent COVID-19 and haematological malignancies. Br J Haematol. 2020;190:e16-e20.
    1. Mehta V, Goel S, Kabarriti R, et al. Case fatality rate of cancer patients with COVID-19 in a New York hospital system. Cancer Discov. 2020;10:935-941.
    1. Rogado J, Obispo B, Pangua C, et al. Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid. Clin Transl Oncol. 2020;22:2364-2368.
    1. Stroppa EM, Toscani I, Citterio C, et al. Coronavirus disease-2019 in cancer patients. A report of the first 25 cancer patients in a western country (Italy). Future Oncol. 2020;16:1425-1432.
    1. Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21:914-922.
    1. Yang K, Sheng Y, Huang C, et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21:904-913.
    1. Yarza R, Bover M, Paredes D, et al. SARS-CoV-2 infection in cancer patients undergoing active treatment: analysis of clinical features and predictive factors for severe respiratory failure and death. Eur J Cancer. 2020;135:242-450.
    1. Vuagnat P, Frelaut M, Ramtohul T, et al. COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area. Breast Cancer Res. 2020;22:55.
    1. Luo J, Rizvi H, Egger JV, Preeshagul IR, Wolchok JD, Hellmann MD. Impact of PD-1 blockade on severity of COVID-19 in patients with lung cancers. Cancer Discov. 2020;10:1121-1128.
    1. Kabarriti R, Brodin NP, Maron MI, et al. Extent of prior lung irradiation and mortality in COVID-19 patients with a cancer history. Adv Radiat Oncol. 2020;5:707-710.
    1. Assaad S, Avrillon V, Fournier M-L, et al. High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR. Eur J Cancer. 2020;135:251-259.
    1. Miyashita H, Mikami T, Chopra N, et al. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol. 2020;31:1088-1089.
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052-2059.
    1. Karagiannidis C, Mostert C, Hentschker C, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020;8:853-862.
    1. Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020;20:565-567.
    1. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med. 2020;382:2534-2543.
    1. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584:430-436.
    1. Chen Z, Wherry EJ. T cell responses in patients with COVID-19. Nat Rev Immunol. 2020;20:529-536.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi