Cancer and COVID-19 (multiple reviews)

Added December 3, 2020

What is this? The COVID-19 pandemic is having an impact on cancer care and cancer patients. Several systematic reviews are summarised here, including rapid reviews of COVID-19 infection in cancer patients and the treatment and management of cancer patients during the COVID-19 pandemic. More details on each review, including citations and links to the full versions, are provided lower down this page.

What was found: Overall, the studies included in these reviews suggest that people with cancer may be more likely to contract COVID-19 than people without cancer and may be at higher risk of severe infection, complications and death. Recommendations have been made to try and protect cancer patients from COVID-19 infection, which include delaying treatment, but this may impact on their cancer outcomes.

The Moujaess review (search done on 5 April 2020) found that COVID-19 can present differently in patients with cancer compared to the general population, which might make COVID-19 diagnosis more challenging in patients with cancer. They also reported that cancer treatments and cancer research had been adversely affected by the COVID-19 pandemic.

The Giannakoulis review (search done on 27 April 2020) found that COVID-19 patients with cancer had higher all-cause mortality than COVID-19 patients without cancer and that they were more likely to need ICU admission.

The Afshar review (search done on 7 May 2020) found case fatality rates in patients with COVID-19 and cancer ranging from 5.5% to 60% and that the proportion of severe COVID-19 cases was higher in patients with cancer than in those without cancer.

The reviews by Tian (search done on 23 April 2020) and Zaki (search done before 23 June 2020) found that cancer patients may be at higher risk of COVID-19 infection, severe infection and poorer outcomes.

The Spolverato review (search done on 4 April 2020) found that recommendations to reduce infection and mortality from COVID-19 in cancer patients included postponing non-essential treatments, providing patients with adequate PPE, case-by-case evaluation for surgery and separate facilities.

The Fligor review (search done on 23 March 2020) found that delayed surgery for colorectal cancer may worsen survival, but that the impact on outcomes for patients with pancreatic or gastric cancer was unclear. The authors noted that neoadjuvant treatment should be considered if surgery is delayed.

The Garg review (search done on 2 May 2020) found many cancer guidelines that had been rapidly developed during the COVID-19 pandemic, which were based on limited evidence. They noted marked discordance in recommendations across sub-specialities and concluded that the guidelines should be interpreted with caution.

What are the reviews:

Citation: Afshar ZM, Dayani M, Naderi M, et al. Fatality rate of COVID-19 in patients with malignancies: a systematic review and meta-analysis. The Journal of Infection. 2020;81(2):e114–6.

In this rapid review, the authors searched for studies that reported the case fatality rate of patients with COVID-19 and cancer. They restricted their search to articles published between 30 December 2019 and 7 May 2020. They included 9 studies (805 patients), which were from China (7 studies), Iran (1) and the USA (1).

Citation: Fligor SC, Wang S, Allar BG, et al. Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. Journal of Gastrointestinal Surgery. 2020;24:2357-73.

In this review, the authors searched for studies of the impact of time to surgery on cancer-related outcomes for adults with colorectal, pancreatic or gastric cancer. They restricted their search to studies published in English between 1 January 2005 and 23 March 2020. They included 58 studies, which covered colorectal cancer (43 studies), gastric cancer (6) and pancreatic cancer (9).

Citation: Garg PK, Kaul P, Choudhary D, et al. Discordance of COVID‐19 guidelines for patients with cancer: a systematic review. Journal of surgical oncology. 2020;122(4):579-93.

In this rapid review, the authors searched for published guidance on cancer and COVID-19. They restricted their search to articles published in English and searched up to 2 May 2020. They included 86 guidelines/recommendations/reviews, 25 research articles, 18 case reports/series, 25 editorials and 58 commentary/expert opinion articles. Most of the included guidelines were published in April 2020.

Citation: Giannakoulis VG, Papoutsi E, Siempos II. Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data. JCO Global Oncology. 2020 Jun;6:799-808.

In this rapid review, the authors searched for studies that reported all-cause mortality or need for intensive care unit (ICU) admission in patients with COVID-19, comparing outcomes in patients with cancer to outcomes in patients without cancer. They restricted their searches to articles published in English from 1 January 2020 to 27 April 2020. They included 32 studies (46,499 patients).

Citation: Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Critical Reviews in Oncology/Hematology. 2020 Jun;150:102972.

Free to view: No

In this rapid review, the authors searched for studies that investigated the clinical characteristics of adults with cancer who contracted COVID-19. They restricted their search to articles published in English, French or Chinese since December 2019 and did the search on 5 April 2020. They included 68 opinion publications and 20 observational studies.

Citation: Spolverato G, Capelli G, Restivo A, et al. The management of surgical patients during the COVID-19 pandemic. Surgery. 2020 July;168(1):4-10.

In this rapid review, the authors searched for research or opinion papers on the epidemiology and diagnosis of COVID-19, the management of cancer and surgical patients, and the safety of healthcare workers during the pandemic. They did not restrict their searches by type or language of publication, and searched for articles published since January 1998 on 4 April 2020. They included 28 retrospective studies.

Citation: Tian Y, Qiu X, Wang C, et al. Cancer associates with risk and severe events of COVID‐19: A systematic review and meta‐analysis. International Journal of Cancer. 2021:148:363-74.

In this rapid review, the authors searched for research on the prevalence of cancer in COVID-19 patients and associated outcomes. They restricted their search to studies from China published in English or Chinese, and did the search on 23 April 2020. They included 38 studies (7094 patients).

Citation: Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: a systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(5):1133-42.

In this rapid review, the authors searched for studies assessing the effect of comorbidities, including cancer, on the severity of COVID-19 infection. The search period is not documented but the manuscript was submitted to the journal on 23 June 2020. They included 7 articles focused on cancer.

Other reviews of this topic:

Citation: Crosby DL, Sharma A. Evidence-based guidelines for management of head and neck mucosal malignancies during the COVID-19 pandemic. Otolaryngology–Head and Neck Surgery. 2020:163(1):16-24.

Citation: Russell B, Moss C, George G, et al. Associations between immune-suppressive and stimulating drugs and novel COVID-19: a systematic review of current evidence. Ecancermedicalscience. 2020;14:1022.

Citation: Xing L, Guo X, Bai L, Qian J, Chen J. Are spiritual interventions beneficial to patients with cancer?: a meta-analysis of randomized controlled trials following PRISMA. Medicine. 2018;97(35):e11948.

Citation: Zaorsky NG, James BY, McBride SM, et al. Prostate cancer radiotherapy recommendations in response to COVID-19. Advances in Radiation Oncology. 2020;5(4):659-65. 


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