Risk of COVID‐19 death for people with a pre‐existing cancer diagnosis prior to COVID‐19‐vaccination: A systematic review and meta‐analysis

Author:

Steinberg Julia1ORCID,Hughes Suzanne1,Hui Harriet1,Allsop Matthew J.2,Egger Sam1,David Michael13,Caruana Michael1,Coxeter Peter1,Carle Chelsea1,Onyeka Tonia45,Rewais Isabel1,Monroy Iglesias Maria J.6,Vives Nuria78,Wei Feixue9,Abila Derrick Bary10,Carreras Giulia11,Santero Marilina12,O'Dowd Emma L.13,Lui Gigi1,Tolani Musliu Adetola14,Mullooly Maeve15,Lee Shing Fung1617,Landy Rebecca18ORCID,Hanley Sharon J. B.1920,Binefa Gemma2122,McShane Charlene M.23,Gizaw Muluken242526ORCID,Selvamuthu Poongulali27,Boukheris Houda2829,Nakaganda Annet30,Ergin Isil31,Moraes Fabio Ynoe32,Timilshina Nahari33,Kumar Ashutosh34ORCID,Vale Diama B.35,Molina‐Barceló Ana36,Force Lisa M.3738,Campbell Denise Joan1,Wang Yuqing39,Wan Fang39,Baker Anna‐Lisa39,Singh Ramnik39,Salam Rehana Abdus1,Yuill Susan139,Shah Richa40,Lansdorp‐Vogelaar Iris41ORCID,Yusuf Aasim42,Aggarwal Ajay4344,Murillo Raul4546,Torode Julie S.4748,Kliewer Erich V.49,Bray Freddie40,Chan Kelvin K. W.5051ORCID,Peacock Stuart495152ORCID,Hanna Timothy P.5354,Ginsburg Ophira55,Van Hemelrijck Mieke6ORCID,Sullivan Richard47,Roitberg Felipe565758,Ilbawi André M.57,Soerjomataram Isabelle40,Canfell Karen1

Affiliation:

1. The Daffodil Centre The University of Sydney, a joint venture with Cancer Council NSW Sydney Australia

2. Leeds Institute of Health Sciences University of Leeds Leeds UK

3. School of Medicine and Dentistry Griffith University Gold Coast Australia

4. Department of Anaesthesia/Pain & Palliative Care Unit College of Medicine, University of Nigeria, Ituku‐Ozalla Campus Enugu Nigeria

5. IVAN Research Institute Enugu Nigeria

6. Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health School of Cancer and Pharmaceutical Sciences, King's College London London UK

7. Cancer Screening Unit Institut Català d'Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) Barcelona Spain

8. Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III Madrid Spain

9. Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer Lyon France

10. Makerere University College of Health Sciences Kampala Uganda

11. Oncologic Network, Prevention and Research Institute (ISPRO) Florence Italy

12. Iberoamerican Cochrane Centre, IIB Sant Pau‐Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau Barcelona Spain

13. Department of Respiratory Medicine Nottingham University Hospitals NHS Trust Nottingham UK

14. Department of Surgery Ahmadu Bello University Zaria Nigeria

15. School of Population Health RCSI University of Medicine and Health Sciences Dublin Ireland

16. Department of Radiation Oncology National University Cancer Institute, National University Hospital Singapore

17. Department of Clinical Oncology Tuen Mun Hospital, New Territories West Cluster, Hospital Authority Hong Kong China

18. Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA

19. Department of Academic Primary Care Institute of Applied Health Sciences, University of Aberdeen Aberdeen Scotland

20. Center for Environmental and Health Sciences Hokkaido University Sapporo Japan

21. Cancer Screening Unit, Cancer Prevention and Control Program Catalan Institute of Oncology, Hospitalet de Llobregat Barcelona Spain

22. Early Detection of Cancer Research Group EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat Barcelona Spain

23. Centre for Public Health Queen's University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital Belfast Northern Ireland

24. Department of Preventive Medicine, School of Public Health Addis Ababa University Addis Ababa Ethiopia

25. Institute for Medical Epidemiology, Biometrics and Informatics Martin Luther University of Halle‐Wittenberg Halle Germany

26. NCD Working Group School of Public Health, Addis Ababa University Addis Ababa Ethiopia

27. Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services Chennai India

28. University Abderrahmane Mira of Bejaia, School of Medicine Bejaia Algeria

29. Department of Epidemiology and Preventive Medicine University Hospital of Bejaia Bejaia Algeria

30. Department of Cancer Epidemiology and Clinical Trials Uganda Cancer Institute Kampala Uganda

31. Department of Public Health, Faculty of Medicine Ege University Bornova Turkey

32. Department of Oncology Queen's University Kingston Ontario Canada

33. Institute of Health Policy, Management and Evaluation, University of Toronto Toronto Ontario Canada

34. Department of Anatomy All India Institute of Medical Sciences‐Patna Patna India

35. Department of Obstetrics and Gynecology University of Campinas (UNICAMP) Campinas Brazil

36. Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO Valencia Spain

37. Department of Health Metrics Sciences, Division of Hematology/Oncology University of Washington Seattle Washington USA

38. Department of Pediatrics, Division of Hematology/Oncology University of Washington Seattle Washington USA

39. School of Public Health University of Sydney Sydney New South Wales Australia

40. Cancer Surveillance Branch, International Agency for Research on Cancer Lyon France

41. Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

42. Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar Lahore Pakistan

43. Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine King's College London London UK

44. Department of Oncology Guy's & St Thomas NHS Trust London UK

45. Centro Javeriano De Oncologia – Hospital Universitario San Ignacio Bogotá Colombia

46. Pontificia Universidad Javeriana Bogotá Colombia

47. Institute of Cancer Policy, King's College London London UK

48. Research Oncology Bermondsey Wing, Guy's Hospital London UK

49. Department of Cancer Control Research BC Cancer Research Institute Vancouver British Columbia Canada

50. Odette Cancer Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada

51. Canadian Centre for Applied Research in Cancer Control Vancouver British Columbia Canada

52. Faculty of Health Sciences, Simon Fraser University Burnaby British Columbia Canada

53. Division of Cancer Care and Epidemiology Cancer Research Institute at Queen's University Kingston Ontario Canada

54. Department of Oncology and Department of Public Health Sciences Queen's University Kingston Ontario Canada

55. Center for Global Health, National Cancer Institute Rockville Maryland USA

56. Department of Non‐Communicable Diseases World Health Organisation Geneva Switzerland

57. Hospital Sírio Libanês São Paulo Brazil

58. Rede Ebserh, Rede Brasileira de Serviços Hospitalares Brasília Brazil

Abstract

AbstractWhile previous reviews found a positive association between pre‐existing cancer diagnosis and COVID‐19‐related death, most early studies did not distinguish long‐term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher‐quality evidence on risk of COVID‐19‐related death for people with recent/active cancer (compared to people without) in the pre‐COVID‐19‐vaccination period. We searched the WHO COVID‐19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk‐of‐bias assessment was based on the Newcastle‐Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse‐variance random‐effects models. Random‐effects meta‐regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID‐19‐related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36‐1.61, I2 = 0; people with COVID‐19: aOR = 1.58, 95% CI: 1.41‐1.77, I2 = 0.58; inpatients with COVID‐19: aOR = 1.66, 95% CI: 1.34‐2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4‐4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68‐2.68, I2 = 0.43), and for metastatic cancers. Meta‐regression suggested risk of COVID‐19‐related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37‐1.75) at 1 year and aOR = 0.98 (95% CI: 0.80‐1.20) at 5 years post‐cancer diagnosis/treatment. In conclusion, before COVID‐19‐vaccination, risk of COVID‐19‐related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Funder

National Health and Medical Research Council

World Health Organization

Publisher

Wiley

Subject

Cancer Research,Oncology

Reference82 articles.

1. World Health Organization.WHO Coronavirus (COVID‐19) Dashboard 2023.https://covid19.who.int/. Accessed 1 October 2023

2. The WHO estimates of excess mortality associated with the COVID-19 pandemic

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

4. World Health Organization.Coronavirus disease (COVID‐19): Vaccines.2022https://www.who.int/emergencies/diseases/novel‐coronavirus‐2019/question‐and‐answers‐hub/q‐a‐detail/coronavirus‐disease‐(covid‐19)‐vaccines?adgroupsurvey=%7badgroupsurvey%7d&gclid=EAIaIQobChMIq82b8‐7v‐wIVUCsrCh1J0QCkEAAYASAAEgLYfvD_BwE. Accessed 12 December 2022

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