Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis

Julia Steinberg; Suzanne Hughes; Harriet Hui; Matthew J. Allsop; Sam Egger; Michael David; Michael Caruana; Peter Coxeter; Chelsea Carle; Tonia Onyeka; Isabel Rewais; Maria J. Monroy Iglesias; Nuria Vives; Feixue Wei; Derrick Bary Abila; Giulia Carreras; Marilina Santero; Emma L. O'Dowd; Gigi Lui; Musliu Adetola Tolani; Maeve Mullooly; Shing Fung Lee; Rebecca Landy; Sharon J.B. Hanley; Gemma Binefa; Charlene M. McShane; Muluken Gizaw; Poongulali Selvamuthu; Houda Boukheris; Annet Nakaganda; Isil Ergin; Fabio Ynoe Moraes; Nahari Timilshina; Ashutosh Kumar; Diama B. Vale; Ana Molina-Barceló; Lisa M. Force; Denise Joan Campbell; Yuqing Wang; Fang Wan; Anna Lisa Baker; Ramnik Singh; Rehana Abdus Salam; Susan Yuill; Richa Shah; Iris Lansdorp-Vogelaar; Aasim Yusuf; Ajay Aggarwal; Raul Murillo; Julie S. Torode; Erich V. Kliewer; Freddie Bray; Kelvin K.W. Chan; Stuart Peacock; Timothy P. Hanna; Ophira Ginsburg; Mieke Van Hemelrijck; Richard Sullivan; Felipe Roitberg; André M. Ilbawi; Isabelle Soerjomataram; Karen Canfell

doi:10.1002/ijc.34798

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis

Julia Steinberg^*, Suzanne Hughes, Harriet Hui, Matthew J. Allsop, Sam Egger, Michael David, Michael Caruana, Peter Coxeter, Chelsea Carle, Tonia Onyeka, Isabel Rewais, Maria J. Monroy Iglesias, Nuria Vives, Feixue Wei, Derrick Bary Abila, Giulia Carreras, Marilina Santero, Emma L. O'Dowd, Gigi Lui, Musliu Adetola TolaniMaeve Mullooly, Shing Fung Lee, Rebecca Landy, Sharon J.B. Hanley, Gemma Binefa, Charlene M. McShane, Muluken Gizaw, Poongulali Selvamuthu, Houda Boukheris, Annet Nakaganda, Isil Ergin, Fabio Ynoe Moraes, Nahari Timilshina, Ashutosh Kumar, Diama B. Vale, Ana Molina-Barceló, Lisa M. Force, Denise Joan Campbell, Yuqing Wang, Fang Wan, Anna Lisa Baker, Ramnik Singh, Rehana Abdus Salam, Susan Yuill, Richa Shah, Iris Lansdorp-Vogelaar, Aasim Yusuf, Ajay Aggarwal, Raul Murillo, Julie S. Torode, Erich V. Kliewer, Freddie Bray, Kelvin K.W. Chan, Stuart Peacock, Timothy P. Hanna, Ophira Ginsburg, Mieke Van Hemelrijck, Richard Sullivan, Felipe Roitberg, André M. Ilbawi, Isabelle Soerjomataram, Karen Canfell

^*Corresponding author for this work

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Abstract

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I² = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I² = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I² = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I² = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Original language	English
Pages (from-to)	1394-1412
Number of pages	19
Journal	International Journal of Cancer
Volume	154
Issue number	8
DOIs	https://doi.org/10.1002/ijc.34798
Publication status	Published - 15 Apr 2024

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Publisher Copyright:
© 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

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Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccinationFinal published version, 4.21 MBLicence: CC BY

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Steinberg, J., Hughes, S., Hui, H., Allsop, M. J., Egger, S., David, M., Caruana, M., Coxeter, P., Carle, C., Onyeka, T., Rewais, I., Monroy Iglesias, M. J., Vives, N., Wei, F., Abila, D. B., Carreras, G., Santero, M., O'Dowd, E. L., Lui, G., ... Canfell, K. (2024). Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis. International Journal of Cancer, 154(8), 1394-1412. https://doi.org/10.1002/ijc.34798

@article{e37014f1655444c186f97dc4320af588,

title = "Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis",

abstract = "While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.",

author = "Julia Steinberg and Suzanne Hughes and Harriet Hui and Allsop, {Matthew J.} and Sam Egger and Michael David and Michael Caruana and Peter Coxeter and Chelsea Carle and Tonia Onyeka and Isabel Rewais and {Monroy Iglesias}, {Maria J.} and Nuria Vives and Feixue Wei and Abila, {Derrick Bary} and Giulia Carreras and Marilina Santero and O'Dowd, {Emma L.} and Gigi Lui and Tolani, {Musliu Adetola} and Maeve Mullooly and Lee, {Shing Fung} and Rebecca Landy and Hanley, {Sharon J.B.} and Gemma Binefa and McShane, {Charlene M.} and Muluken Gizaw and Poongulali Selvamuthu and Houda Boukheris and Annet Nakaganda and Isil Ergin and Moraes, {Fabio Ynoe} and Nahari Timilshina and Ashutosh Kumar and Vale, {Diama B.} and Ana Molina-Barcel{\'o} and Force, {Lisa M.} and Campbell, {Denise Joan} and Yuqing Wang and Fang Wan and Baker, {Anna Lisa} and Ramnik Singh and Salam, {Rehana Abdus} and Susan Yuill and Richa Shah and Iris Lansdorp-Vogelaar and Aasim Yusuf and Ajay Aggarwal and Raul Murillo and Torode, {Julie S.} and Kliewer, {Erich V.} and Freddie Bray and Chan, {Kelvin K.W.} and Stuart Peacock and Hanna, {Timothy P.} and Ophira Ginsburg and {Van Hemelrijck}, Mieke and Richard Sullivan and Felipe Roitberg and Ilbawi, {Andr{\'e} M.} and Isabelle Soerjomataram and Karen Canfell",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.",

year = "2024",

month = apr,

day = "15",

doi = "10.1002/ijc.34798",

language = "English",

volume = "154",

pages = "1394--1412",

journal = "International Journal of Cancer",

issn = "0020-7136",

publisher = "Wiley-Liss Inc.",

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Steinberg, J, Hughes, S, Hui, H, Allsop, MJ, Egger, S, David, M, Caruana, M, Coxeter, P, Carle, C, Onyeka, T, Rewais, I, Monroy Iglesias, MJ, Vives, N, Wei, F, Abila, DB, Carreras, G, Santero, M, O'Dowd, EL, Lui, G, Tolani, MA, Mullooly, M, Lee, SF, Landy, R, Hanley, SJB, Binefa, G, McShane, CM, Gizaw, M, Selvamuthu, P, Boukheris, H, Nakaganda, A, Ergin, I, Moraes, FY, Timilshina, N, Kumar, A, Vale, DB, Molina-Barceló, A, Force, LM, Campbell, DJ, Wang, Y, Wan, F, Baker, AL, Singh, R, Salam, RA, Yuill, S, Shah, R, Lansdorp-Vogelaar, I, Yusuf, A, Aggarwal, A, Murillo, R, Torode, JS, Kliewer, EV, Bray, F, Chan, KKW, Peacock, S, Hanna, TP, Ginsburg, O, Van Hemelrijck, M, Sullivan, R, Roitberg, F, Ilbawi, AM, Soerjomataram, I & Canfell, K 2024, 'Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis', International Journal of Cancer, vol. 154, no. 8, pp. 1394-1412. https://doi.org/10.1002/ijc.34798

TY - JOUR

T1 - Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination

T2 - A systematic review and meta-analysis

AU - Steinberg, Julia

AU - Hughes, Suzanne

AU - Hui, Harriet

AU - Allsop, Matthew J.

AU - Egger, Sam

AU - David, Michael

AU - Caruana, Michael

AU - Coxeter, Peter

AU - Carle, Chelsea

AU - Onyeka, Tonia

AU - Rewais, Isabel

AU - Monroy Iglesias, Maria J.

AU - Vives, Nuria

AU - Wei, Feixue

AU - Abila, Derrick Bary

AU - Carreras, Giulia

AU - Santero, Marilina

AU - O'Dowd, Emma L.

AU - Lui, Gigi

AU - Tolani, Musliu Adetola

AU - Mullooly, Maeve

AU - Lee, Shing Fung

AU - Landy, Rebecca

AU - Hanley, Sharon J.B.

AU - Binefa, Gemma

AU - McShane, Charlene M.

AU - Gizaw, Muluken

AU - Selvamuthu, Poongulali

AU - Boukheris, Houda

AU - Nakaganda, Annet

AU - Ergin, Isil

AU - Moraes, Fabio Ynoe

AU - Timilshina, Nahari

AU - Kumar, Ashutosh

AU - Vale, Diama B.

AU - Molina-Barceló, Ana

AU - Force, Lisa M.

AU - Campbell, Denise Joan

AU - Wang, Yuqing

AU - Wan, Fang

AU - Baker, Anna Lisa

AU - Singh, Ramnik

AU - Salam, Rehana Abdus

AU - Yuill, Susan

AU - Shah, Richa

AU - Lansdorp-Vogelaar, Iris

AU - Yusuf, Aasim

AU - Aggarwal, Ajay

AU - Murillo, Raul

AU - Torode, Julie S.

AU - Kliewer, Erich V.

AU - Bray, Freddie

AU - Chan, Kelvin K.W.

AU - Peacock, Stuart

AU - Hanna, Timothy P.

AU - Ginsburg, Ophira

AU - Van Hemelrijck, Mieke

AU - Sullivan, Richard

AU - Roitberg, Felipe

AU - Ilbawi, André M.

AU - Soerjomataram, Isabelle

AU - Canfell, Karen

PY - 2024/4/15

Y1 - 2024/4/15

N2 - While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

AB - While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

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U2 - 10.1002/ijc.34798

DO - 10.1002/ijc.34798

M3 - Article

C2 - 38083979

AN - SCOPUS:85179341144

SN - 0020-7136

VL - 154

SP - 1394

EP - 1412

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 8

ER -

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis

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