Table 1.
Summary of the studies included in the meta-analysisa
| Study | Study design | Country | Median age, y | No. and/or % of patients with specific Cancer subtypes | Comments |
|---|---|---|---|---|---|
| Dai et al. 2020 (23) | Retrospective; multicenter (n = 105) | China | 64 | Lung = 20.95%; GI = 12.38%; breast = 10.48%; thyroid = 10.48%; hematologic = 8.57% | Death rates (OR= 2.34, 95% CI = 1.15 to 4.77; P = .03), ICU admission (OR = 2.84, 95% CI = 1.59 to 5.08; P < .01), severe or critical symptom (OR = 2.79, 95% CI = 1.74 to 4.41; P < .01). |
| He et al. 2020 (24) | Retrospective; multicenter (n = 13) | China | 35 | AML = 4; ALL = 5; plasma cell myeloma = 3; MDS = 1 | 8 of 13 with hematological cancers and COVID-19 died. Need for mechanical ventilation: 1 of 13 |
| Joharatnam-Hogan et al. 2020 (25) | Retrospective; multicenter (n = 26) | UK | 76 | Colorectal = 5; prostate cancer = 5; others = 16 | 3 of 26 of cancer patients received noninvasive ventilatory support, all of whom died; 3 of 6 who died received chemotherapy; and 3 of 6 who died received targeted treatment. |
| Yu et al. 2020 (26) | Retrospective; single center (n = 12) | China | 66 | NSCLC = 7; colorectal = 2; pancreatic = 1; breast = 1; urothelial = 1 | 3 of 12 patients died; 2 of 7 NSCLC died, 1 of 1 pancreatic cancer died, 1 patient on chemo radiotherapy, 1 patient on follow-up after treatment, and 1 patient on best supportive care died. |
| Liang et al. 2020 (17) | Retrospective, cancer database China (n = 18) | China | 63 | Lung = 5 | Cancer patients had higher risk of severe events compared with patients without cancer (9 [50%] of 18 patients vs 245 [16%] of 1572 patients; P = .0008). |
| Luo et al. 2020 (9) | Retrospective; single center (n = 69) | USA | 69 | Lung = 69 | Mortality rate: 16 of 67 (24%); rate of severe disease a composite of ICU/intubation/transition to DNI status: 24 of 65 (37%); rate of hospitalization: 42 of 67 (63%). |
| Mehta et al. 2020 (6) | Retrospective; single center (n = 218) | USA | 69 | GU = 39; breast = 24; colorectal = 13; gynecologic = 8; lung = 5; head and neck = 7; neuro = 7; hematologic = 34 | 61 of 218 (28%) patients expired. The mortality was 25% of all solid tumor patients and was seen to occur at higher rates in lung cancers (55%) and hematologic malignancies (37%). Active chemotherapy and radiation therapy treatment were not associated with increased case fatality. |
| Miyashita et al. 2020 (27) | Retrospective; single center (n = 334) | USA | NA | Breast = 57; prostate = 56; lung = 23; urothelial = 18; colon = 16 | 37 of 334 cancer patients intubated and died; 314 of 5354 noncancer patients intubated, and 518 patients died. |
| Montopoli et al. 2020 (28) | Retrospective; multicenter (n = 786) | Italy | NA | Prostate = 118; GU = 73; colorectal cancer = 65; hematological = 47 | 47.0% (n = 2131) of male patients were hospitalized, and 6.9% (n = 312) died, and among patients with cancer, 67.9% (n = 292) were hospitalized, and 17.4% (n = 75) died. 0 of 4 patients infected with COVID-19 on anti-androgen therapy (ADT) died; 18 of 114 (16%) prostate cancer patients not on ADT died. |
| Martin-Moro et al. 2020 (29) | Retrospective; single center (n = 34) | Spain | 72.5 | Acute leukemia = 7; MDS = 3; CLL = 6; lymphoma = 6; plasma cell dyscrasia = 7 | 11 (32%) of 34 died. Acute leukemia: 4 of 7 (57%) patients died; MDS: 3 of 3 patients died; plasma cell dyscrasia: 1 of 7 (14%) patients died; myeloproliferative neoplasm: 3 of 5 (60%) patients died. |
| Robilotti et al. 2020 (30) | Retrospective; single center (n = 423) | USA | NA | Hematologic = 103 (25%); breast = 86 (20%); colorectal = 37 (9%); lung = 35 (8%); prostate = 26 (6%) |
Death: 39 of 423 (9%); mechanical ventilation: 39 (9%). Treatment with immunotherapy also remained an independent predictor of severe respiratory illness. Lung cancer severe illness: 15 of 35 (43%); others severe illness: 39 of 240 (16%). Severe illness in immunotherapy: 12 of 31 (39%) Severe illness in non-immunotherapy: 42 of 244 (17%) |
| Vuagnat et al. 2020 (31) | Prospective; cohort; single center (n = 59) | France | 58 | Breast | 28 of 59 patients (47%) were hospitalized. No association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. |
| Wang et al. 2020 (15) | Retrospective; multicenter (n = 283) | China | 63 | Lung = 51 (18%); breast = 38 (13%); colorectal = 34 (12%) |
Overall mortality rate was 18% (50 of 283). The current cancer patients exhibited worse outcomes vs former cancer patients (overall survival, HR = 2.45, 95% CI = 1.10 to 5.44; P = .02; mortality rate, 21% vs 9%). Higher mortality rate observed in lymphohematopoietic malignancies (53%, 9 of 17). The highest mortality rate observed in patients receiving recent chemotherapy (33%), followed by surgery (26%), other antitumor treatments (19%), and no antitumor treatment (15%). |
| Yang et al. 2020 (32) | Retrospective; single center (n = 52) | China | 63 | Lung = 19.2%; breast = 17.3%; rectal = 15.4%; colon = 9.6%; cervical = 7.7%; thyroid = 5.8% | 10 (19.2%) patients received anticancer treatment within 1 month. 11 severe or critical patients died in this study; 2 of 11 received chemotherapy; 1 had undergone surgery. |
| Zhang et al. 2020 (16) | Retrospective; multicenter (n = 67) | China | 66 | Lung = 15 |
23 (34.3%) patients had received anticancer treatment recently; 18 (26.9%) patients died from COVID-19. Lung cancer accounted for the highest proportion of COVID-19–resulted deaths (33.3%, 5 of 15); digestive system cancers (5 of 17, 29.4%) died. |
| Zhang et al. 2020 (33) | Retrospective; multicenter (n = 28) | China | 65 | Lung = 7; oesophageal = 4; breast cancer = 3; head and neck = 3 | 15 (53.6%) patients had severe events, and the mortality rate was 28.6%. If the last antitumor treatment was within 14 days, it statistically significantly increased the risk of developing severe events (HR = 4.079, 95% CI = 1.086 to 15.322; P = .037). |
| Stroppa et al. 2020 (34) | Retrospective; single center (n = 25) | Italy | 71 | Lung = 8; GI tumor = 6; GU = 6; breast = 2, hematologic = 2; undefined site = 1 | 12 (48%) patients were treated with anticancer therapy: 8 (66.67%) with chemotherapy and 4 (33.33%) with immunotherapy; 9 of 25 patients died; 2 breast cancer patients, 3 GU patients, 2 hematological malignancy patients, and 2 lung cancer patients died. |
| Basse et al. 2020 (35) | Retrospective; single center (n = 141) | France | 62 | Breast = 40%; lung = 13%; hematological = 13%; gynecological = 9% | 26 (18%) died from COVID-19. Lung cancers had the worst outcome (n = 6, ie, 23% of all deaths) followed by hematological malignancies (n = 5; 19%), breast (n = 5, 19%), and gynecological cancers (n = 2; 7%). |
| Russell et al. 2020 (36) | Retrospective; single center (n = 106) | UK | 67 | Urological/gynecological = 34%; hematological = 18%; breast = 15% | 14 cancer patients died of COVID-19 (13%). |
| Rafi Kabaritti et al. 2020 (37) | Retrospective; single center (n = 107) | USA | 70 | Breast = 28; prostate = 27; lung = 14 | 24 patients died; lung cancer diagnosis was also associated with increased risk of death (HR = 2.96, 95% CI = 1.09 to 9.27; P = .034). Cox proportional hazards models demonstrated a statistically significant association between mean radiotherapy dose delivered to the lungs and risk of death (HR = 1.12 per Gy, 95% CI = 1.04 to 1.20; P = .002). |
| Deng et al. 2020 (38) | Retrospective; database (n = 107) | China | NA | NA | 6 cancer patients died (5.6%); overall mortality rate: 2.3%. |
| Ma et al. 2020 (39) | Retrospective; single center (n = 37) | China | 62 | Colorectal = 29.7%; lung = 21.6%; breast = 18.9% | 5 (13.5%) cancer patients died. |
| Cook et al. 2020 (40) | Retrospective (n = 75) | UK | 73 | Multiple myeloma | 41 of 73 patients died. |
| Kalinsky et al. 2020 (41) | Retrospective (n = 27) | USA | 56 | Breast cancer | 16 (59%) received chemotherapy, 12 (44%) hormone therapy, 6 (22%) HER2-directed therapy, 1 (4%) checkpoint inhibitor, 6 (22%) breast surgery, and 2 (7%) radiation therapy. 1 of 27 patients died. |
| Gonzalez-Cao et al. 2020 (42) | Retrospective (n = 50) | Spain | 69 | Malignant melanoma | Mortality rates from COVID-19 according to melanoma treatment type were 16%, 15%, and 36% for patients on immunotherapy and targeted drugs and for those who were not undergoing active cancer treatment, respectively. |
| Fratino et al. 2020 (43) | Database retrospective multicenter (n = 20 534) | Italy | NA | NA | 150 of 20 534 patients died of COVID-19 disease. |
a
ALL = acute lymphocytic leukemia; AML = acute myeloid leukemia; CI = confidence interval; DNI = do not intubate; GI = gastrointestinal; GU = genitourinary; HR = hazard ratio; NA = not applicable; NSCLC = non–small cell lung cancer; MDS = myelodysplastic syndrome; OR = odds ratio.