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

Int J Cancer. 2024 Apr 15;154(8):1394-1412. doi: 10.1002/ijc.34798. Epub 2023 Dec 11.

Authors

Julia Steinberg¹, Suzanne Hughes¹, Harriet Hui¹, Matthew J Allsop², Sam Egger¹, Michael David^{1

3}, Michael Caruana¹, Peter Coxeter¹, Chelsea Carle¹, Tonia Onyeka^{4

5}, Isabel Rewais¹, Maria J Monroy Iglesias⁶, Nuria Vives^{7

8}, Feixue Wei⁹, Derrick Bary Abila¹⁰, Giulia Carreras¹¹, Marilina Santero¹², Emma L O'Dowd¹³, Gigi Lui¹, Musliu Adetola Tolani¹⁴, Maeve Mullooly¹⁵, Shing Fung Lee^{16

17}, Rebecca Landy¹⁸, Sharon J B Hanley^{19

20}, Gemma Binefa^{21

22}, Charlene M McShane²³, Muluken Gizaw^{24

25

26}, Poongulali Selvamuthu²⁷, Houda Boukheris^{28

29}, Annet Nakaganda³⁰, Isil Ergin³¹, Fabio Ynoe Moraes³², Nahari Timilshina³³, Ashutosh Kumar³⁴, Diama B Vale³⁵, Ana Molina-Barceló³⁶, Lisa M Force^{37

38}, Denise Joan Campbell¹, Yuqing Wang³⁹, Fang Wan³⁹, Anna-Lisa Baker³⁹, Ramnik Singh³⁹, Rehana Abdus Salam¹, Susan Yuill^{1

39}, Richa Shah⁴⁰, Iris Lansdorp-Vogelaar⁴¹, Aasim Yusuf⁴², Ajay Aggarwal^{43

44}, Raul Murillo^{45

46}, Julie S Torode^{47

48}, Erich V Kliewer⁴⁹, Freddie Bray⁴⁰, Kelvin K W Chan^{50

51}, Stuart Peacock^{49

51

52}, Timothy P Hanna^{53

54}, Ophira Ginsburg⁵⁵, Mieke Van Hemelrijck⁶, Richard Sullivan⁴⁷, Felipe Roitberg^{56

57

58}, André M Ilbawi⁵⁷, Isabelle Soerjomataram⁴⁰, Karen Canfell¹

Affiliations

¹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
² Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
³ School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
⁴ Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.
⁵ IVAN Research Institute, Enugu, Nigeria.
⁶ Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
⁷ Cancer Screening Unit, Institut Català d'Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
⁸ Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain.
⁹ Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
¹⁰ Makerere University College of Health Sciences, Kampala, Uganda.
¹¹ Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
¹² Iberoamerican Cochrane Centre, IIB Sant Pau-Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹³ Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁴ Department of Surgery, Ahmadu Bello University, Zaria, Nigeria.
¹⁵ School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
¹⁶ Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore.
¹⁷ Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China.
¹⁸ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
¹⁹ Department of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
²⁰ Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan.
²¹ Cancer Screening Unit, Cancer Prevention and Control Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.
²² Early Detection of Cancer Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain.
²³ Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland.
²⁴ Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
²⁵ Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University of Halle-Wittenberg, Halle, Germany.
²⁶ NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
²⁷ Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India.
²⁸ University Abderrahmane Mira of Bejaia, School of Medicine, Bejaia, Algeria.
²⁹ Department of Epidemiology and Preventive Medicine, University Hospital of Bejaia, Bejaia, Algeria.
³⁰ Department of Cancer Epidemiology and Clinical Trials, Uganda Cancer Institute, Kampala, Uganda.
³¹ Department of Public Health, Faculty of Medicine, Ege University, Bornova, Turkey.
³² Department of Oncology, Queen's University, Kingston, Ontario, Canada.
³³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³⁴ Department of Anatomy, All India Institute of Medical Sciences-Patna, Patna, India.
³⁵ Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil.
³⁶ Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO, Valencia, Spain.
³⁷ Department of Health Metrics Sciences, Division of Hematology/Oncology, University of Washington, Seattle, Washington, USA.
³⁸ Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle, Washington, USA.
³⁹ School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
⁴⁰ Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
⁴¹ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴² Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar, Lahore, Pakistan.
⁴³ Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, King's College London, London, UK.
⁴⁴ Department of Oncology, Guy's & St Thomas NHS Trust, London, UK.
⁴⁵ Centro Javeriano De Oncologia - Hospital Universitario San Ignacio, Bogotá, Colombia.
⁴⁶ Pontificia Universidad Javeriana, Bogotá, Colombia.
⁴⁷ Institute of Cancer Policy, King's College London, London, UK.
⁴⁸ Research Oncology, Bermondsey Wing, Guy's Hospital, London, UK.
⁴⁹ Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada.
⁵⁰ Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁵¹ Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.
⁵² Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
⁵³ Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Ontario, Canada.
⁵⁴ Department of Oncology and Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
⁵⁵ Center for Global Health, National Cancer Institute, Rockville, Maryland, USA.
⁵⁶ Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland.
⁵⁷ Hospital Sírio Libanês, São Paulo, Brazil.
⁵⁸ Rede Ebserh, Rede Brasileira de Serviços Hospitalares, Brasília, Brazil.

PMID: 38083979
PMCID: PMC10922788 (available on 2025-04-15)
DOI: 10.1002/ijc.34798

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.

Keywords: COVID-19; cancer; death; meta-analysis; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

COVID-19 Testing
COVID-19* / epidemiology
Humans
Neoplasms* / diagnosis
Neoplasms* / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding