J Rhinol.  2023 Jul;30(2):69-79. 10.18787/jr.2023.00015.

Prognostic Factors for Survival or Severity After COVID-19 Infection in Cancer Patients: A Systematic Review and Meta-Analysis

• Lee EJ
• Cho JH

• KMID: 2544616
• DOI: http://doi.org/10.18787/jr.2023.00015

Abstract

Background and Objectives
Cancer organizations worldwide have recently released care guidelines for cancer patients with coronavirus disease 2019 (COVID-19). Several studies have reported higher mortality rates in cancer patients with COVID-19. However, drawing robust conclusions remains challenging due to a lack of research on clinical prognostic factors in this patient group.
Methods
A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane databases. We searched the keywords in the following combination: (“COVID-19” or “coronavirus” or “wuhan virus”) and (“cancer”). The search was performed on August 1, 2020, and only papers written in English were included in this study. We collected data from 3,215 cancer patients with COVID-19 from 16 studies and analyzed overall mortality after COVID-19 infection in cancer patients compared to controls, as well as prognostic factors for severity and mortality after COVID-19 infection. The prognostic factors analyzed encompassed demographics, comorbidities, symptoms, cancer treatment within 4 weeks of COVID-19 diagnosis, and treatment for COVID-19 infection.
Results
This meta-analysis evaluated mortality rates and related prognostic factors in cancer patients infected with COVID-19. First, 15 of the 16 studies reported mortality data; 663 patients died among a total of 3,215 people, resulting in a combined mortality rate of 21%. Second, the following poor prognostic factors were identified: male sex, older age (≥65 years), respiratory symptoms (e.g., cough and dyspnea), and other comorbidities (e.g., cardiovascular disease, hypertension, and chronic obstructive pulmonary disease).
Conclusion
The mortality of cancer patients infected with COVID-19 can reach about 20%.

Keyword

COVID-19; Cancer; Prognosis; Mortality; Meta-analysis

Figure

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  Fig. 1. Selection flowchart of included studies.

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  Fig. 2. Forest plot for mortality after COVID-19 infection in cancer patients [5,9-13,15-23]. CI, confidence interval.

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  Fig. 3. Forest plot for sex, age, and metastasis. Men exhibited a worse prognosis than women. The prognosis was also worse for people over 65 years of age or with metastasis [5,9-19,21-23]. CI, confidence interval.

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  Fig. 4. Forest plot for comorbidities. Cardiovascular disease, hypertension, and chronic obstructive pulmonary disease were associated with a poor prognosis. Obesity had no significant effects. Diabetes seemed to be related to a poor prognosis, but it was not statistically significant [5,9-13,16,17,19,21,23]. CI, confidence interval.

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  Fig. 5. Forest plot for symptoms related to COVID-19. Fever and gastrointestinal (GI) symptoms did not affect the prognosis. Respiratory symptoms, including cough and dyspnea, were mainly associated with a poor prognosis. Patients who required oxygen (O2) supplementation also had a poor prognosis [12,13,15-17,19-21,23]. CI, confidence interval.

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  Fig. 6. Forest plot for cancer treatment within 4 weeks of COVID-19 diagnosis. A: No cancer treatments including immunotherapy, targeted therapy, surgery, and radiotherapy received within 4 weeks of the COVID-19 diagnosis were related to patients’ prognosis. B: Forest plot for COVID-19 treatment. The combination of hydroxychloroquine and azithromycin had no significant effect on the prognosis [9-14,16,17,19,22,23]. CI, confidence interval.

Reference

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