In a systematic review and meta-analysis reported in JAMA Network Open, Khoury et al found that SARS–CoV-2 infection was associated with a higher risk of mortality among patients with cancer vs those without cancer. Risk vs those with no cancer was increased with younger age, and patients with lung cancer and hematologic cancer were at greatest risk.
Study Details
The meta-analysis included 81 studies and 61,532 patients with cancer. Among 58,849 patients with cancer with available data, 52% were male and the median age across studies ranged from 35 to 74 years. Countries with the highest numbers of patients represented were the United States, United Kingdom, Italy, France, and China.
Results of this study suggest that patients with cancer and SARS–CoV-2 infection had a higher risk of death than patients without cancer. Younger age, lung cancer, and hematologic cancer were also risk factors associated with poor outcomes from COVID-19.— Khoury et al
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Key Findings
In age- and sex-matched analysis, the relative risk (RR) of mortality from COVID-19 among patients with vs without cancer was 1.69 (95% confidence interval [CI] =1.46–1.95, P < .001). The risk of mortality among patients with vs without cancer decreased with increasing age (exp [b], or odds ratio = 0.96, 95% CI = 0.92–0.99, P = .03).
By type of treatment among patients with cancer, chemotherapy was associated with the highest overall pooled case fatality rate, at 30% (95% CI = 25%–36%) and endocrine therapy with the lowest, at 11% (95% CI = 6%–16%). Immunotherapy was associated with a rate of 19% (95% CI = 13%–25%), surgery within 3 months of COVID-19 diagnosis was associated with a rate of 19% (95% CI = 9%–29%), radiotherapy was associated with a rate of 23% (95% CI = 12%–33%), and targeted therapy was associated with a rate of 18% (95% CI = 12%–23%).
By cancer type, lung cancer (pooled case fatality rate = 30%; RR vs control patients = 1.68, 95% CI = 1.45–1.94, P < .001) and hematologic cancers (rate = 32%; RR = 1.42, 95% CI = 1.31–1.54, P < .001) were associated with the greatest risk of mortality. Genitourinary cancers (rate = 22%; RR = 1.11, 95% CI = 1.00–1.24, P = .06) and gastrointestinal cancers (rate = 16%; RR = 1.13, 95% CI = 0.93–1.37, P = .21) were associated with a numerically greater risk. Skin cancers (rate = 10%; RR = 0.85, 95% CI = 0.60–1.20) were associated with a numerically reduced risk. Breast cancer (rate = 9%; RR = 0.51, 95% CI = 0.36–0.71, P < .001) and gynecologic cancers (rate = 12%; RR = 0.76, 95% CI = 0.62–0.93, P = .009) were associated with a significantly reduced risk.
The investigators concluded, “Results of this study suggest that patients with cancer and SARS–CoV-2 infection had a higher risk of death than patients without cancer. Younger age, lung cancer, and hematologic cancer were also risk factors associated with poor outcomes from COVID-19.”
Carlo Palmieri, BSc, MBBS, PhD, of the Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by the UK Research Innovation-Department for Health and Social Care COVID-19 Rapid Response Rolling Call, Cancer Research UK, U.S. FDA Medical Countermeasures Initiative, Wellcome Trust, and others. For full disclosures of the study authors, visit jamanetwork.com.
