Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data

JCO Glob Oncol. 2020 Jun:6:799-808. doi: 10.1200/GO.20.00225.

Abstract

Purpose: Whether cancer is associated with worse prognosis among patients with COVID-19 is unknown. We aimed to quantify the effect (if any) of the presence as opposed to absence of cancer on important clinical outcomes of patients with COVID-19 by carrying out a systematic review and meta-analysis.

Methods: We systematically searched PubMed, medRxiv, COVID-19 Open Research Dataset (CORD-19), and references of relevant articles up to April 27, 2020, to identify observational studies comparing patients with versus without cancer infected with COVID-19 and to report on mortality and/or need for admission to the intensive care unit (ICU). We calculated pooled risk ratios (RR) and 95% CIs with a random-effects model. The meta-analysis was registered with PROSPERO (CRD42020181531).

Results: A total of 32 studies involving 46,499 patients (1,776 patients with cancer) with COVID-19 from Asia, Europe, and the United States were included. All-cause mortality was higher in patients with versus those without cancer (2,034 deaths; RR, 1.66; 95% CI, 1.33 to 2.07; P < .0001; 8 studies with 37,807 patients). The need for ICU admission was also more likely in patients with versus without cancer (3,220 events; RR, 1.56; 95% CI, 1.31 to 1.87; P < .0001; 26 studies with 15,375 patients). However, in a prespecified subgroup analysis of patients > 65 years of age, all-cause mortality was comparable between those with versus without cancer (915 deaths; RR, 1.06; 95% CI, 0.79 to 1.41; P = .71; 8 studies with 5,438 patients).

Conclusion: The synthesized evidence suggests that cancer is associated with worse clinical outcomes among patients with COVID-19. However, elderly patients with cancer may not be at increased risk of death when infected with COVID-19. These findings may inform discussions of clinicians with patients about prognosis and may guide health policies.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Betacoronavirus / pathogenicity*
  • COVID-19
  • Cause of Death
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / mortality
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / virology
  • Critical Care*
  • Female
  • Hospital Mortality
  • Host-Pathogen Interactions
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / mortality
  • Neoplasms / therapy*
  • Observational Studies as Topic
  • Pandemics
  • Patient Admission
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Risk Assessment
  • Risk Factors
  • SARS-CoV-2
  • Treatment Outcome