Estimating the Risk of Death from COVID-19 in Adult Cancer Patients

Abstract

Aims During the coronavirus disease 2019 (COVID-19) pandemic, organisations have produced management guidance for cancer patients and the delivery of cytotoxic chemotherapy, but none has offered estimates of risk or the potential impact across populations. Materials and methods We combined data from four countries to produce pooled age-banded case fatality rates, calculated the sex difference in survival and used data from four recent studies to convert case fatality rates into age/sex-stratified infection fatality rates (IFRs). We estimated the additional risk of death in cancer patients and in those receiving chemotherapy. We illustrate the impact of these by considering the impact on a national incident cancer cohort and analyse the risk–benefit in some clinical scenarios. Results We obtained data based on 412 985 cases and 41 854 deaths. The pooled estimate for IFR was 0.92%. IFRs for patients with cancer ranged from 0 to 29% and were higher in patients receiving chemotherapy (0.01–46%). The risk was significantly higher with age and in men compared with women. 37.5% of patients with a new diagnosis of cancer in 2018 had an IFR ≥5%. Survival benefits from adjuvant chemotherapy ranged from 5 to 10% in some common cancers, compared with the increased risk of death from COVID-19 of 0–3%. Conclusions Older male patients are at a higher risk of death with COVID-19. Patients with cancer are also at a higher risk, as are those who have recently received chemotherapy. We provide well-founded estimates to allow patients and clinicians to better balance these risks and illustrate the wider impact in a national incident cohort.

The Impact of the COVID-19 Pandemic on Oncology Care and Clinical Trials

“…The risk of contracting COVID-19 versus the impact of delaying treatment was not clearly understood. However, analytical studies conducted by many research centers in more recent times have statistically defined the survival benefit cancer therapy to outweigh the increased risk of COVID-19 fatality [32].…”

COVID-19 in 96 Patients With Hematologic Disease: The First Single-center Experience From the Czech Republic

“…Although the infection fatality rate for COVID-19 is approximately 1% in the general population, it may exceed 30% among patients with cancer. 2 , 3 Published studies report significantly higher mortality associated with COVID-19 in patients with hematologic malignancies older than 60 years and those not achieving a complete remission (CR) of their disease. 4 , 5 , 6 The groups most at risk are patients with acquired bone marrow failure and acute leukemia who were found to have higher infection fatality rates than those with lymphoproliferative disorders.…”

Mortality in patients with cancer and SARS-CoV-2 infection: Results from the Argentinean Network of Hospital-Based Cancer Registries

“…Patients from the UKCCMP tend to be older, with a greater probability to require hospitalization and having adverse events. Conversely, our CFR is considerably higher than that found by Williams [23] , who used the infection fatality rate (IFR) in order to correct for the ascertainment bias (when only more ill patients are tested for the disease).…”