The COVID-19 and Cancer Consortium (CCC19)

Current Evidence on COVID-19 and Cancer

 COVID19 and Cancer Prevalence:

 Liang et al. [1] described a cohort of 18 patients with a history of cancer amongst the 1590 COVID-19 positive cases. The study showed higher prevalence of cancer (1%; 95% CI 0·61–1·65) compared to the overall Chinese population (0·29%). Lung cancer was the most frequent cancer in this cohort found in 5/18 (28%). Patients with a diagnosis of cancer were observed to have a higher risk of severe events (a composite endpoint defined as the percentage of patients being admitted to the intensive care unit requiring invasive ventilation, or death) compared with patients without cancer (7/18 [39%] vs 124/1572 [8%]; Fisher’s exact p=0·0003). Patients who underwent chemotherapy or surgery in the past month had a numerically higher risk (3/4 [75%] patients) of clinically severe events than did those not receiving chemotherapy or surgery (6/14 [43%] patients). Important limitations of this study were retrospective nature of the study and potential confounding from a higher median age among the cancer patients, smoking history, small sample size, heterogeneity of cancer types, variable disease courses (from 0–16 years), and diverse treatment strategies that may not be generalizable to overall population with cancer.


Another study from Italy by Onder et al. [2] reported a subsample of 355 patients with COVID-19 who died, of which 72 (20.3%) had active cancer.


Desai et al. found that the overall pooled prevalence of cancer in patients with COVID-19 among 11 studies was 2.0% (95% CI, 2.0% to 3.0%; I2 = 83.2%). On further subgroup analysis based on sample size, studies with a sample size < 100 had a slightly higher prevalence at 3.0% (95% CI, 1.0% to 6.0%), while larger studies, with a  sample size > 100, had a lower overall prevalence of 2.0% (95%  CI, 1.0% to 3.0%). [3] 


Dai et al. reported a pre-print (non-peer reviewed) of an observational study of 105 hospitalized patients with history of cancer and compared it to 233 hospitalized patients with no history of cancer [4].  Patients with lung cancer (n=22 patients), blood cancers (n=9),  esophageal cancers (n=6) had the highest mortality and ICU admission rates (lung=18% mortality, 27% ICU admission; blood cancer= 33% mortality, 44% ICU admission,  esophageal cancer=16% mortality, 33% ICU admissions).  Only 17/105 patients had metastatic cancers. 48/105 received some form of cancer specific therapy and only 27/48 received some form of systemic therapy with in 40 days. Only 17 patients received chemo and only 6 patients received immuenotherpy. On multivariate analyis, severe COVID-19 symptoms (OR=2·12 (p=0·01)) and need for mechanical ventilation were significant (OR=3·04 (p=0·03)).Rates of deaths and ICU admission were not significantly different.


Infection rates in patients with cancer:

Yu et al. [5] reported infection rate of SARS-CoV-2 in patients with cancer as 0.79% (12 of 1524 patients; 95% CI, 0.3%-1.2%). Patients with cancer harbored a higher risk of SARS-CoV-2 infection (OR, 2.31; 95% CI, 1.89-3.02) compared with the community.

Of the 1524 patients with cancer, 228 (14.96%) patients had NSCLC. Patients with NSCLC older than 60 years had a higher incidence of COVID-19 than those aged 60 years or younger (4.3% vs 1.8%). 

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References

1) Liang W, Guan W, Chen R, Wang W, Li J, Xu K, Li C, Ai Q, Lu W, Liang H, Li S, He J. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020 Mar;21(3):335-337. Epub 2020 Feb 14. https://doi.org/10.1016/S1470-2045(20)30096-6

2) Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683

3) Desai A, Sachdeva S, Parekh T, Desai R. COVID-19 and Cancer: Lessons  From a Pooled Meta-Analysis. JCO global oncology. 2020 Apr;6:557.  DOI: 10.1200/GO.20.00097  

4) Dai, Meng-Yuan and Liu, Dianbo and Liu, Miao and Zhou, Fu-Xiang and Li, Gui-Ling and Chen, Zhen and Zhang, Zhi-An and You, Hua and Wu, Meng and Zhen, Qi-Chao and Xiong, Yong and Xiong, Hui-Hua and Wang, Chun and Chen, Chang-Chun and Xiong, Fei and Zhang, Yan and Peng, Ya-Qin and Ge, Si-Ping and Zhen, Bo and Yu, Ting-Ting and Wang, Ling and Wang, Hua and Liu, Yu and Chen, Ye-Shan and Mei, Jun-Hua and Gao, Xiao-Jia and Li, Zhu-Yan and Gan, Li-Juan and He, Can and Li, Zhen and Shi, Yu-Ying and Qi, Yu-Wen and Yang, Jing and Tenen, Daniel G. and Chai, Li and Mucci, Lorelei Ann and Santillana, Mauricio and Cai, Hong-Bing, Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multi-Center Study During the COVID-19 Outbreak (3/17/2020). Available at SSRN: https://ssrn.com/abstract=3558017 or http://dx.doi.org/10.2139/ssrn.3558017

5) Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China. JAMA Oncol. Published online March 25, 2020. doi:10.1001/jamaoncol.2020.0980