Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Freeman, Victoria; Hughes, Suzanne; Carle, Chelsea; Campbell, Denise; Egger, Sam; Hui, Harriet; Yap, Sarsha; Deandrea, Silvia; Onyeka, Tonia C.; IJzerman, Maarten Joost; Ginsburg, Ophira; Bray, Freddie; Sullivan, Richard; Aggarwal, Ajay; Peacock, Stuart; Chan, Kelvin; Hanna, Timothy P.; Soerjomataram, Isabelle; O’Connell, Dianne; Steinberg, Julia; Canfell, Karen

doi:10.1016/j.jcpo.2022.100340

Cited by 10 publications

(10 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding of a higher likelihood of death for people with a pre‐existing diagnosis of cancer aligns with findings of evidence syntheses published during the first 12 months of the COVID‐19 pandemic 4,56‐61 . Similar to earlier reviews, 59,62 our included studies reported an increased mortality risk for people with COVID‐19 and hematological cancers.…”

Section: Discussionsupporting

confidence: 89%

“…Our finding of a higher likelihood of death for people with a pre-existing diagnosis of cancer aligns with findings of evidence syntheses published during the first 12 months of the COVID-19 pandemic. 4,[56][57][58][59][60][61] Similar to earlier reviews, 59,62 our included studies reported an increased mortality risk for people with COVID-19 and hematological cancers. However, earlier literature was characterized by pervasive biases and analytical limitations, including multiple sources of bias (eg, a lack of adjustment for at least age and sex), with many studies having short follow-up periods, small numbers of people with cancer, unclear definitions of cancer status and substantial overlap between data included in different early studies.…”

Section: Discussionsupporting

confidence: 79%

“…Cancer was included among the conditions associated with severe COVID‐19 and COVID‐19‐related death in the WHO Clinical Guidelines for COVID‐19, with other conditions including diabetes, hypertension and immunosuppression 3 . A systematic review of the early‐stage pandemic literature to 1 July 2020 4 found a positive association between pre‐existing cancer diagnosis and COVID‐19‐related death from studies that adjusted for at least age and sex. However, most of these early studies considered the risk associated with any pre‐existing cancer diagnosis (both long‐term cancer survivors and those recently diagnosed/treated), without explicitly considering time since diagnosis/treatment or adjusting for important confounders including other conditions associated with COVID‐19‐related death.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of COVID‐19 death for people with a pre‐existing cancer diagnosis prior to COVID‐19‐vaccination: A systematic review and meta‐analysis

Steinberg,

Hughes,

Hui

et al. 2023

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

While previous reviews found a positive association between pre‐existing cancer diagnosis and COVID‐19‐related death, most early studies did not distinguish long‐term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher‐quality evidence on risk of COVID‐19‐related death for people with recent/active cancer (compared to people without) in the pre‐COVID‐19‐vaccination period. We searched the WHO COVID‐19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk‐of‐bias assessment was based on the Newcastle‐Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse‐variance random‐effects models. Random‐effects meta‐regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID‐19‐related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36‐1.61, I2 = 0; people with COVID‐19: aOR = 1.58, 95% CI: 1.41‐1.77, I2 = 0.58; inpatients with COVID‐19: aOR = 1.66, 95% CI: 1.34‐2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4‐4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68‐2.68, I2 = 0.43), and for metastatic cancers. Meta‐regression suggested risk of COVID‐19‐related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37‐1.75) at 1 year and aOR = 0.98 (95% CI: 0.80‐1.20) at 5 years post‐cancer diagnosis/treatment. In conclusion, before COVID‐19‐vaccination, risk of COVID‐19‐related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of COVID‐19 death for people with a pre‐existing cancer diagnosis prior to COVID‐19‐vaccination: A systematic review and meta‐analysis

Steinberg,

Hughes,

Hui

et al. 2023

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…To control this new infectious disease, studies on the risk of infection and death have been reported, and chronic diseases, including cancer, have been reported as major risk factors of death in patients infected with COVID-19 2–4. A systematic review, including cohort or case-control studies, reported that a pre-existing cancer diagnosis significantly increased the risk of COVID-related death 2.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors of mortality in patients with cancer infected with COVID-19: a systematic review protocol

2023

View full text Add to dashboard Cite

IntroductionThe COVID-19 pandemic has resulted in many cases of infection and deaths worldwide. Patients with cancer are a high-risk group for COVID-19-related death. However, a systematic summary of the prognostic factors related to mortality in these patients is limited. We systematically summarise the evidence on the prognostic factors of mortality in patients with pre-existing cancer, infected with COVID-19.Methods and analysisWe will address the prognostic factors for mortality, including cohort studies of adult patients with cancer infected with COVID-19. We will search MEDLINE, Embase and Cochrane Central Libraries for data from December 2019 to the present day. The prognostic factors for mortality include general, cancer-related and clinical characteristics. We will not limit the COVID-19 severity, cancer type and follow-up period of the included studies. Two reviewers will independently and in duplicate conduct reference screening, data abstraction and risk of bias assessment. We will perform a random-effect meta-analysis to calculate the pooled relative effect estimates for each prognostic factor of mortality. We will assess the risk of bias for each included study and rate the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study will provide information about high-risk groups for mortality in patients with cancer infected with COVID-19.Ethics and disseminationThis study will use only the published references and would not need to obtain ethical approval. We will disseminate our study findings through a peer-reviewed journal.PROSPERO registration numberCRD42023390905.

show abstract

“…Early reports suggested increased mortality risk potentially due to a compromised immune system, especially for lung and haematological cancers. However, the early evidence was characterised by multiple sources of bias and methodological problems such as inadequate follow‐up, limited patient numbers, limited ascertainment of cancer status, and lack of adjustment for confounders such as comorbidities 15 . Ongoing work by the International Partnership for Resilience in Cancer Systems (formerly the COVID‐19 and Cancer Global Modelling Consortium) 16 will result in an updated international evidence synthesis on this topic.…”

mentioning

confidence: 99%

The complex impact of COVID‐19 on cancer outcomes in Australia

Canfell,

Chiam,

Nickson

et al. 2023

Medical Journal of Australia

Self Cite

View full text Add to dashboard Cite

Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Cited by 10 publications

References 85 publications

Risk of COVID‐19 death for people with a pre‐existing cancer diagnosis prior to COVID‐19‐vaccination: A systematic review and meta‐analysis

Risk of COVID‐19 death for people with a pre‐existing cancer diagnosis prior to COVID‐19‐vaccination: A systematic review and meta‐analysis

Prognostic factors of mortality in patients with cancer infected with COVID-19: a systematic review protocol

The complex impact of COVID‐19 on cancer outcomes in Australia

Contact Info

Product

Resources

About