Mortality in patients with cancer and COVID-19: A systematic review and pooled analysis of 52 studies

Saini, Kamal S.; Tagliamento, Marco; Lambertini, Matteo; McNally, Richard; Romano, Marco; Leone, Manuela; Curigliano, Giuseppe; de Azambuja, Evandro

BACKGROUND: Patients with COVID-19 who have underlying malignancy have a higher mortality rate compared with those without cancer, although the magnitude of such excess risk is not clearly defined. We performed a systematic review and pooled analysis to provide precise estimates of the mortality rate among patients with both cancer and COVID-19. METHODS: A systematic literature search involving peer reviewed publications, preprints, and conference proceedings up to July 16, 2020 was performed. The primary endpoint was the case fatality rate (CFR), defined as rate of death among patients with cancer and COVID-19. The CFR was assessed with a random effects model, which was used to derive a pooled CFR and its 95% confidence interval (CI). RESULTS: 52 studies, involving a total of 18,650 patients with both COVID-19 and cancer were selected for the pooled analysis. A total of 4,243 deaths were recorded in this population. The probability of death was 25·6% (95% CI 22·0% to 29·9%; I(2)=48·9%) in this patient population. CONCLUSIONS: Patients with cancer who develop COVID-19 have high probability of mortality. Appropriate and aggressive preventive measures must be taken to reduce the risk of COVID-19 in patients with cancer, and to optimally manage those who do contract the infection.