Aakash Desai1, Rohit Gupta2, Shailesh Advani3,4, Lara Ouellette5, Nicole M Kuderer6, Gary H Lyman7,8, Ang Li8,9. 1. Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota. 2. School of Medicine, Baylor College of Medicine, Houston, Texas. 3. Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland. 4. Cancer Prevention and Control Program, Department of Oncology, Georgetown University School of Medicine, Georgetown, Washington. 5. Texas Medical Center Library, Houston, Texas. 6. Advanced Cancer Research Group, Kirkland, Washington. 7. Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington. 8. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington. 9. Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas.
Abstract
BACKGROUND: Heterogeneous evidence exists on the effect of coronavirus disease 2019 (COVID-19) on the clinical outcomes of patients with cancer. METHODS: A systematic review was performed using the Medline, Embase, and CENTRAL databases and the World Health Organization Novel Coronavirus website to identify studies that reported mortality and characteristics of patients with cancer who were diagnosed with COVID-19. The primary study outcome was mortality, defined as all-cause mortality or in-hospital mortality within 30 days of initial COVID-19 diagnosis. The pooled proportion of mortality was estimated using a random-effects model, and study-level moderators of heterogeneity were assessed through subgroup analysis and metaregression. RESULTS: Among 2922 patients from 13 primarily inpatient studies of individuals with COVID-19 and cancer, the pooled 30-day mortality rate was 30% (95% CI, 25%-35%). The overall pooled 30-day mortality rate among 624 patients from 5 studies that included a mixture of inpatient and outpatient populations was 15% (95% CI, 9%-22%). Among the hospitalized studies, the heterogeneity (I2 statistic) of the meta-analysis remained high (I2 , 82%). Cancer subtype (hematologic vs solid), older age, male sex, and recent active cancer therapy each partially explained the heterogeneity of mortality reporting. In multivariable metaregression, male sex, along with an interaction between the median patient age and recent active cancer therapy, explained most of the between-study heterogeneity (R2 , 96%). CONCLUSIONS: Pooled mortality estimates for hospitalized patients with cancer and COVID-19 remain high at 30%, with significant heterogeneity across studies. Dedicated community-based studies are needed in the future to help assess overall COVID-19 mortality among the broader population of patients with cancer.
BACKGROUND: Heterogeneous evidence exists on the effect of coronavirus disease 2019 (COVID-19) on the clinical outcomes of patients with cancer. METHODS: A systematic review was performed using the Medline, Embase, and CENTRAL databases and the World Health Organization Novel Coronavirus website to identify studies that reported mortality and characteristics of patients with cancer who were diagnosed with COVID-19. The primary study outcome was mortality, defined as all-cause mortality or in-hospital mortality within 30 days of initial COVID-19 diagnosis. The pooled proportion of mortality was estimated using a random-effects model, and study-level moderators of heterogeneity were assessed through subgroup analysis and metaregression. RESULTS: Among 2922 patients from 13 primarily inpatient studies of individuals with COVID-19 and cancer, the pooled 30-day mortality rate was 30% (95% CI, 25%-35%). The overall pooled 30-day mortality rate among 624 patients from 5 studies that included a mixture of inpatient and outpatient populations was 15% (95% CI, 9%-22%). Among the hospitalized studies, the heterogeneity (I2 statistic) of the meta-analysis remained high (I2 , 82%). Cancer subtype (hematologic vs solid), older age, male sex, and recent active cancer therapy each partially explained the heterogeneity of mortality reporting. In multivariable metaregression, male sex, along with an interaction between the median patient age and recent active cancer therapy, explained most of the between-study heterogeneity (R2 , 96%). CONCLUSIONS: Pooled mortality estimates for hospitalized patients with cancer and COVID-19 remain high at 30%, with significant heterogeneity across studies. Dedicated community-based studies are needed in the future to help assess overall COVID-19mortality among the broader population of patients with cancer.
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Authors: Aakash Desai; Justin F Gainor; Aparna Hegde; Alison M Schram; Giuseppe Curigliano; Sumanta Pal; Stephen V Liu; Balazs Halmos; Roman Groisberg; Enrique Grande; Tomislav Dragovich; Marc Matrana; Neeraj Agarwal; Sant Chawla; Shumei Kato; Gilberto Morgan; Pashtoon M Kasi; Benjamin Solomon; Herbert H Loong; Haeseong Park; Toni K Choueiri; Ishwaria M Subbiah; Naveen Pemmaraju; Vivek Subbiah Journal: Nat Rev Clin Oncol Date: 2021-03-15 Impact factor: 66.675