A comprehensive systematic review and meta-analysis of the global data involving 61,532 cancer patients with SARS-CoV-2 infection

Background

SARS-CoV-2 have been shown to be associated with more severe disease and death in cancer patient. A systematic review and meta-analysis was conducted to determine the risk by age, tumour type and treatment of infection with SARS-CoV-2 in cancer patients.

Methods

Systematic review by searching PubMed, Web of Science, and Scopus for articles published in English up to June 14, 2021 of SARS-CoV-2 infection in >10 patients with malignant disease. Outcomes included factors in patients with malignant disease that may predict a poor outcome from COVID-19 compared to patients without malignant disease, including patient demographics, tumour subtype and cancer treatments. A meta-analysis was performed using random effects model.

Results

81 studies were included, totalling 61,532 cancer patients. Haematological malignancies comprised 22.1% (9,672 of 43,676) of cases. Relative risk (RR) of mortality when age and sex matched was 1.69 (95% CI, 1.46-1.95; p<0.001; I²=51%). RR of mortality, versus non-cancer patients, was associated with decreasing age (exp(b)0.96; 95% CI, 0.922–0.994; p=0.028) but not male sex (exp(b)1.89; 95% CI, 0.222–6.366; p=0.83). RR of mortality in those with haematological malignancies versus non-cancer control was 1.81 (95% CI, 1.53-2.95; I²=0.0%). Compared to other cancers, increased risk of death was seen for lung (RR 1.68, 95% CI, 1.45-1.94; p<0.001), genitourinary (RR 1.11; 95% CI, 1.00-1.24; p=0.059) and haematological malignancies (RR 1.42; 95% CI, 1.31-1.54; p<0.001). Breast (RR 0.51; 95% CI, 0.36-0.71; p<0.001) and gynaecological cancers (RR 0.76; 95% CI, 0.62-0.93; p=0.009) had lower risk of death. Receipt of chemotherapy had greatest overall pooled mortality risk of 30% (95% CI, 25-36%; I²=86.97%) and endocrine therapy the lowest at 11% (95% CI, 6-16%; I²=70.7%).

Conclusions

Cancer patients, particularly younger cancer patients, appear at increased risk of mortality from COVID-19 compared to non-cancer patients. Differences in outcomes were seen based on tumour types and treatment.

Highlights

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  To our knowledge this is the largest review and meta-analysis of COVID-19 in cancer patients with insights into tumour types and therapies.

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  In unadjusted analysis cancer doubles the risk of COVID-19 related mortality. This decreased when adjusted for age and sex.

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  Younger cancer patients have the highest risk of mortality when compared to non-cancer COVID-19 patient of a similar age.

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  Patients with lung, genitourinary and haematological malignancies are at increased risk of mortality, breast and gynaecological cancers are at lower risk.

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  Patients on chemotherapy have the highest pooled mortality risk with those on endocrine therapy the lowest.