Age-Sex based estimates of risk of death from COVID Infection in Adult Cancer Patients

Background

During the coronavirus disease 2019 (COVID) pandemic, various organisations have produced management guidance for cancer patients and the delivery of cytotoxic chemotherapy, but none offer estimates of risk, or the potential impact across populations.

Methods

We combine data from four countries to produce pooled age-banded Case Fatality Rates (CFRs), calculate the sex-difference in survival and use data from four recent studies to convert CFRs into age-sex stratified Infection Fatality Rates (IFRs). We estimate 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 present some clinical scenarios.

Results

We obtained data based on 412,985 cases and 41,854 deaths. The pooled estimate for IFR was 0.92%. Age-related IFRs for patients with cancer range from 0.01% to 29%, and higher in patients receiving chemotherapy. The risk is significantly higher in men than women. 40% of all male and 32% of all female patients with a new diagnosis of cancer this year have an IFR of ≥ 5%.

Conclusions

Older male patients are at a higher risk of death with COVID infection. Patients with cancer are also at 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.

FUNDING & DISCLOSURES

MW receives funding from the Imperial/ NIHR BRC; SD receives funding from the IC/ICR CRUK Major Centre; LPS receives funding from Brain Tumour Research and the Brain Tumour Research Campaign. JC is supported by the Guangdong International Young Research Talents Training Programme for Postdoctoral Researchers. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Code, data and appendicies are available at:<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://gitlab.com/computational.oncology/covidcancerrisk">https://gitlab.com/computational.oncology/covidcancerrisk</ext-link>

HIGHLIGHTS

• We report case and infection fatality rates based on a large multi-national cohort

• We provide sex and age-specific estimates of risk

• We provide estimates of additional risk for patients with cancer to allow patients and clinicians to balance risk and benefit