Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Victoria Freeman; Suzanne Hughes; Chelsea Carle; Denise Campbell; Sam Egger; Harriet Hui; Sarsha Yap; Silvia Deandrea; Michael Caruana; Tonia C. Onyeka; Maarten J. IJzerman; Ophira Ginsburg; Freddie Bray; Richard Sullivan; Ajay Aggarwal; Stuart J. Peacock; Kelvin K.W. Chan; Timothy P. Hanna; Isabelle Soerjomataram; Dianne L. O'Connell; Julia Steinberg; Karen Canfell

doi:10.1016/j.jcpo.2022.100340

Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Victoria Freeman, Suzanne Hughes, Chelsea Carle, Denise Campbell, Sam Egger, Harriet Hui, Sarsha Yap, Silvia Deandrea, Michael Caruana, Tonia C. Onyeka, Maarten J. IJzerman, Ophira Ginsburg, Freddie Bray, Richard Sullivan, Ajay Aggarwal, Stuart J. Peacock, Kelvin K.W. Chan, Timothy P. Hanna, Isabelle Soerjomataram, Dianne L. O'ConnellJulia Steinberg^*, Karen Canfell

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

4 Citations (Scopus)

Abstract

Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. Methods and findings: We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59–4.20, adjusted OR=1.37,95%CI:1.16–1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33–2.08; five studies, adjusted HR=1.19,95%CI:1.02–1.38). Conclusions: The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.

Original language	English
Article number	100340
Journal	Journal of Cancer Policy
Volume	33
DOIs	https://doi.org/10.1016/j.jcpo.2022.100340
Publication status	Published - Sept 2022

Keywords

COVID-19
Mortality
Neoplasms
SARS-CoV-2

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcpo.2022.100340

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Freeman, V., Hughes, S., Carle, C., Campbell, D., Egger, S., Hui, H., Yap, S., Deandrea, S., Caruana, M., Onyeka, T. C., IJzerman, M. J., Ginsburg, O., Bray, F., Sullivan, R., Aggarwal, A., Peacock, S. J., Chan, K. K. W., Hanna, T. P., Soerjomataram, I., ... Canfell, K. (2022). Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence. Journal of Cancer Policy, 33, [100340]. https://doi.org/10.1016/j.jcpo.2022.100340

@article{215d7cb7f7264b3d8c5212070d5f8c48,

title = "Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence",

abstract = "Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. Methods and findings: We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59–4.20, adjusted OR=1.37,95%CI:1.16–1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33–2.08; five studies, adjusted HR=1.19,95%CI:1.02–1.38). Conclusions: The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.",

keywords = "COVID-19, Mortality, Neoplasms, SARS-CoV-2",

author = "Victoria Freeman and Suzanne Hughes and Chelsea Carle and Denise Campbell and Sam Egger and Harriet Hui and Sarsha Yap and Silvia Deandrea and Michael Caruana and Onyeka, {Tonia C.} and IJzerman, {Maarten J.} and Ophira Ginsburg and Freddie Bray and Richard Sullivan and Ajay Aggarwal and Peacock, {Stuart J.} and Chan, {Kelvin K.W.} and Hanna, {Timothy P.} and Isabelle Soerjomataram and O'Connell, {Dianne L.} and Julia Steinberg and Karen Canfell",

note = "Funding Information: Prof Karen Canfell reports that she is co-PI of an investigator-initiated trial of cervical screening, {"}Compass{"}, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. KC is also co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc.”. Funding Information: No specific funding was received for this study. Professor Karen Canfell receives salaray support from the National Health and Medical Research Council Australia ( APP1194679 ). Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = sep,

doi = "10.1016/j.jcpo.2022.100340",

language = "English",

volume = "33",

journal = "Journal of Cancer Policy",

issn = "2213-5383",

publisher = "Elsevier BV",

}

Freeman, V, Hughes, S, Carle, C, Campbell, D, Egger, S, Hui, H, Yap, S, Deandrea, S, Caruana, M, Onyeka, TC, IJzerman, MJ, Ginsburg, O, Bray, F, Sullivan, R , Aggarwal, A, Peacock, SJ, Chan, KKW, Hanna, TP, Soerjomataram, I, O'Connell, DL, Steinberg, J & Canfell, K 2022, 'Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence', Journal of Cancer Policy, vol. 33, 100340. https://doi.org/10.1016/j.jcpo.2022.100340

TY - JOUR

T1 - Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

AU - Freeman, Victoria

AU - Hughes, Suzanne

AU - Carle, Chelsea

AU - Campbell, Denise

AU - Egger, Sam

AU - Hui, Harriet

AU - Yap, Sarsha

AU - Deandrea, Silvia

AU - Caruana, Michael

AU - Onyeka, Tonia C.

AU - IJzerman, Maarten J.

AU - Ginsburg, Ophira

AU - Bray, Freddie

AU - Sullivan, Richard

AU - Aggarwal, Ajay

AU - Peacock, Stuart J.

AU - Chan, Kelvin K.W.

AU - Hanna, Timothy P.

AU - Soerjomataram, Isabelle

AU - O'Connell, Dianne L.

AU - Steinberg, Julia

AU - Canfell, Karen

N1 - Funding Information: Prof Karen Canfell reports that she is co-PI of an investigator-initiated trial of cervical screening, "Compass", run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. KC is also co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc.”. Funding Information: No specific funding was received for this study. Professor Karen Canfell receives salaray support from the National Health and Medical Research Council Australia ( APP1194679 ). Publisher Copyright: © 2022

PY - 2022/9

Y1 - 2022/9

N2 - Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. Methods and findings: We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59–4.20, adjusted OR=1.37,95%CI:1.16–1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33–2.08; five studies, adjusted HR=1.19,95%CI:1.02–1.38). Conclusions: The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.

AB - Background: Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. Methods and findings: We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59–4.20, adjusted OR=1.37,95%CI:1.16–1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33–2.08; five studies, adjusted HR=1.19,95%CI:1.02–1.38). Conclusions: The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.

KW - COVID-19

KW - Mortality

KW - Neoplasms

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85131960717&partnerID=8YFLogxK

U2 - 10.1016/j.jcpo.2022.100340

DO - 10.1016/j.jcpo.2022.100340

M3 - Review article

C2 - 35680113

AN - SCOPUS:85131960717

SN - 2213-5383

VL - 33

JO - Journal of Cancer Policy

JF - Journal of Cancer Policy

M1 - 100340

ER -

Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence

Abstract

Keywords

UN SDGs

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