TABLE 1.
Main points extracted from supportive and opposing studies which were reviewed up to the date of submission.
| Critical Points | Studies in agreement | Opposing studies | Suggestions |
|---|---|---|---|
| Large studies support increased susceptibility of cancer patients to contract COVID-19, some offering molecular evidence | 9,10,17,18,23-28: No. of patients between 7049 & 72,314 | 29*,30*,31$,32,33#,34#: No. of patients between 178 & 20,899 | Specification of subgroups with the highest risk (e.g. based on race, cancer type, time from diagnosis, etc. |
| Increased age of cancer+COVID-19 patients is associated with increased mortality &/or severe outcome | 41-43,45,46,51,52 | 50 | These patient groups could be prioritized to receive treatment in emergency situations |
| Male cancer+COVID-19 patients are at increased risk of severe disease | 9,41,44,45,46,51 | 31,34,42 | |
| Anti-cancer treatments@ do not significantly increase mortality/ severity of COVID-19 & can even have low infection rates | 32,41,44,47,79,51,53,59,60 | 45,46,52,56 | Cancer treatments should be continued during the pandemic, preferably using a case-by-case approach, depending on patient condition, cancer, treatment, & vaccination status |
| Debate on the effect of race on COVID-19 severity in cancer patients continues: non-whites might be more susceptible. | Positive effect of race on severity: 24,44$,46,52,53 | No effect or reduction in severity: 41,43,45 | Further studies required |
| Debate on the effect of cancer type on COVID-19 severity in cancer patients continues | Hematologic cancer has worse outcome: 42,43,46,47,52 | 31,45,49 | |
| Lung cancer has worse outcome: 27,47 | |||
| Melanoma, uterine & kidney cancer have worse outcome: 42 | |||
| Debate on the effect of hormone-therapy on COVID-19 severity in cancer patients continues | Androgen/Estrogen deprivation & Tamoxifen are partially protective: 9,58,63 | 46,57,62 | Anti-cancer therapy has more benefits than risks and should be continued during the pandemic, but a case-by-case approach is recommended |
| Vaccination data^ | |||
| Cancer patients have generally lower responses to vaccines compared to health individuals | |||
| Solid cancers respond better to vaccines compared to hematologic malignancies | |||
| Anticancer therapy impacts vaccine responses; therefore, vaccination would be more effective when the immune system is less affected by these treatments, i.e., 2 weeks prior to therapy | |||
| Advanced age, certain cancer types like hematological malignancies and treatments causing B-cell depletion or those negatively affecting the immune system can result in less effective immune responses after vaccination | |||
| Boosters should be administered in a timely manner with minimal delay to prevent infection in cancer patients since they are already at a disadvantage regarding immune response & antibody levels | |||
| Third boosters increase immunity and can be beneficial even in seronegative patients | |||
| Regarding the general benefits of vaccination in cancer patients, prioritization should be considered in vaccination schedules for these individuals | |||
These studies have either reported on specific cancer types or used a small sample size
These studies showed decreased chance of infection in cancer patients
In multivariable analysis, hematologic cancers did not have significantly increased mortality compared to solid malignancies, but had the highest mortality among active cancers
These include toxic and non-toxic therapies. The specifics of studies on one or both types have been stated in full within the text
Considering that vaccination in cancer+COVID-19 patients is still being widely investigated, studies have mostly been supportive and their conclusions are presented without stating opposing studies, if any