In a meta-analysis reported in JCO Global Oncology, Desai et al found a pooled prevalence of cancer of 2.0% among patients with COVID-19 infection.
“Overall, current evidence on the association between cancer and COVID-19 remains inconclusive. However, we must give more intensive attention to patients with cancer, especially those undergoing bone marrow or stem cell transplantation, those with hematologic malignancies, and those receiving active treatment, given the higher risk.”— Desai et al
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Key Findings
A literature search identified 11 reports providing data on prevalence of cancer in patients with COVID-19 infection. The overall pooled prevalence of cancer in patients with COVID-19 in the 11 studies was 2.0% (95% confidence interval [CI] = 2.0%–3.0%). In a total of five studies with patient sample sizes ≤ 100, reported cancer prevalence rates ranged from 1% to 6%, with sample sizes ranging from 32 to 99 patients; overall prevalence in these studies was 3.0% (95% CI = 1.0%–6.0%). In a total of six studies with patient sample sizes > 100, reported cancer prevalence rates ranged from 1% to 7% in populations ranging from 137 to 1,590 patients; overall prevalence in these studies was 2.0% (95% CI = 1%–3%).
The authors stated, “Despite these findings, our data are potentially limited by the retrospective nature of the studies used. However, taken together with previously published results, we found that patients with cancer and cancer survivors remain an important at-risk population for COVID-19.”
They noted that limited data indicate a higher risk of clinically severe events among patients with cancer who underwent chemotherapy or surgery in the past month vs those who did not—eg, 75% vs 43% in one study. Given such findings, they pose several questions:
- Should we intentionally postpone adjuvant chemotherapy or elective surgery for patients with cancer with stable disease?
- Should we advise patients with cancer and survivors to use stronger personal protection?
- Is there a role for online medical counseling or identification and treatment of critical patient cases of cancer?
- How should we deal with a potential delay in clinical trials if enforced quarantine complicates hospital attendance for appointments or continuity in care?
The authors observed that currently, there is a lack of evidence or recommendations regarding holding chemotherapy or immunotherapy or delaying adjuvant therapy or radiotherapy treatment in patients with cancer. Additionally, there is currently no evidence indicating an increased risk of pneumonitis in patients receiving immunotherapy or radiotherapy.
In conclusion, the authors stated, “Overall, current evidence on the association between cancer and COVID-19 remains inconclusive. However, we must give more intensive attention to patients with cancer, especially those undergoing bone marrow or stem cell transplantation, those with hematologic malignancies, and those receiving active treatment, given the higher risk.”
Aakash Desai, MBBS, MPH, of the University of Connecticut, Farmington, is the corresponding author for the JCO Global Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
