The Risk and Prognosis of COVID-19 Infection in Cancer Patients

Abstract

Numerous studies have been published regarding outcomes of cancer patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) infection. However, most of these are single-center studies with a limited number of patients. To better assess the outcomes of this new infection in this subgroup of susceptible patients, we performed a systematic review and meta-analysis to evaluate the impact of COVID-19 infection on cancer patients. We performed a literature search using PubMed, Web of Science, and Scopus for studies that reported the risk of infection and complications of COVID-19 in cancer patients and retrieved 22 studies (1018 cancer patients). The analysis showed that the frequency of cancer among patients with confirmed COVID-19 was 2.1% (95% confidence interval [CI]: 1.3–3) in the overall cohort. These patients had a mortality of 21.1% (95% CI: 14.7–27.6), severe/critical disease rate of 45.4% (95% CI: 37.4–53.3), intensive care unit (ICU) admission rate of 14.5% (95% CI: 8.5–20.4), and mechanical ventilation rate of 11.7% (95% CI: 5.5–18). The double-arm analysis showed that cancer patients had a higher risk of mortality (odds ratio [OR] = 3.23, 95% CI: 1.71–6.13), severe/critical disease (OR = 3.91, 95% CI: 2.70–5.67), ICU admission (OR = 3.10, 95% CI: 1.85–5.17), and mechanical ventilation (OR = 4.86, 95% CI: 1.27–18.65) than non-cancer patients. Furthermore, cancer patients had significantly lower platelet levels and higher D-dimer levels, C-reactive protein levels, and prothrombin time. In conclusion, these results indicate that cancer patients are at a higher risk of COVID-19 infection-related complications. Therefore, cancer patients need diligent preventive care measures and aggressive surveillance for earlier detection of COVID-19 infection.

Cumulative COVID-19 incidence, mortality, and prognosis in cancer survivors: a population-based study in Reggio Emilia, Northern Italy

“…Higher fatality and hospitalization rates for COVID-19 patients with a previous diagnosis of cancer have been observed in several studies [11][12][13][14][15][16][17] , including a recent large registry-based Italian study. 11 Instead, we did not find any studies comparing the risk of SARS-CoV-2 infection and COVID-19 death in cancer survivors with that in the general population.…”

“…Only a few case series tried to infer the risk of infection, comparing the prevalence of SARS-CoV-2 infection in cancer patients with that in health care providers 12 or with that in the general population, [13][14][15] or comparing the prevalence of cancer among COVID-19 patients with that in the general population. 16 These studies gave inconsistent results. 12,17 The observed lower probability of being tested and of testing positive could be related to protective behaviours adopted early by people with previous cancer, i.e.…”

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

“…4,5 Since then, several systematic reviews have attempted to assess the impact of cancer on COVID-19 severity and mortality. [6][7][8] However, these studies have been limited by their inclusion criteria, small subgroups of the population, and case duplications. 9 Subsequently, these often lacked the details regarding cancer or cancer treatment and short-term mortality data.…”

Balance on slack line; diagnostic intensity and patient safety during the SARS-CoV-2 pandemic

“…Compared to the general population patients who had no recent chemotherapy exposure had a similar to modestly increased risk of ICU admission or death [5]. Two meta-analyses show case fatality rates (CFR) following COVID-19 of approximately 21-22% in patients with cancer compared to 5.9% in non-cancer patients [8,9]. However, a notable exception is a study from two New York hospitals that included 585 COVID-19 patients and found a similarly high CFR of 25% for patients with cancer and a CFR of 21% for age-sex-comorbidity matched COVID-19 non-cancer patients [10].…”