Institutional review board approval was not required for this study because no patient identifiers were disclosed. The complete search protocol is provided in Supplementary Methods (available online). This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations ( 13).
We performed this systematic review and meta-analysis to interrogate and summarize the lessons learned from the clinical reports on various malignancies that have reported mortality outcomes in cancer patients affected by COVID-19. There remains a multitude of unanswered questions regarding the actual impact of COVID-19 on cancer patients such as differences in survival outcomes in patients with active cancer and cancer survivors, the impact of various oncologic therapies, and difference in outcomes in subtypes of cancer, along with the safety and interaction of COVID-19–directed therapy with cancer-directed therapy. The majority of published reports on cancer patients with COVID-19 have been single institutional retrospective studies with selective reporting of outcomes. The COVID-19 pandemic has caused a conundrum of problems specific to cancer patients such as increasing need for intensive care unit (ICU) admissions and ventilatory support redeployment of resources resulting in delayed cancer care suspension of clinical trials limiting availability of lifesaving therapies delay in diagnostic and screening programs modification of standardized protocols that might compromise cancer control and reduced willingness among cancer patients to visit hospitals owing to the fear of infection ( 11, 12). Lastly, many chemotherapy and targeted therapies require high-dose steroid premedication or therapy and need hospital visits for infusion, both of which predispose to infections.
Detroit diesel diagnostic link 7.09 full driver#
Because the main pathophysiologic driver of mortality in COVID-19 is the cytokine storm and macrophage activation, immunotherapy agents might augment the heightened immune activation seen in severe COVID-19 disease ( 9, 10).
For instance, radiotherapy requires multiple visits to the hospital because of its fractionated nature of the treatment and has been known to deplete circulating and resident T-lymphocyte populations ( 8). Moreover, owing to oncologic interventions and follow-up thereof, time spent in the hospital as well as interaction with health-care providers may further increase the proclivity to develop infections. The majority of cancer patients tend to be older, have multiple preexisting comorbidities, and are immunosuppressed from numerous causes ( 7). However, cancer patients have been reported to have double the case fatality rates as compared with the general population ( 6).
A systematic review showed a pooled prevalence of cancer patients with COVID-19 to be around 2.0% ( 5). Worldwide data suggest that there are around 18 million new cancer patients every year, with around 43 million patients living with a cancer diagnosis within the past 5 years ( 3, 4). COVID-19 has caused an unprecedented global health pandemic, with more than 20 million cases and 0.76 million deaths reported worldwide (at the time of writing) ( 2). Severe acute respiratory syndrome–related coronavirus 2 (SARS-CoV-2) is a novel beta-coronavirus and the causative agent of coronavirus disease 2019 (COVID-19) ( 1).