During the coronavirus disease 2019 (COVID-19) pandemic, organisations have produced management guidance for cancer patients and the delivery of cytotoxic chemotherapy, but none has offered estimates of risk or the potential impact across populations.
We combined data from four countries to produce pooled age-banded case fatality rates, calculated the sex difference in survival and used data from four recent studies to convert case fatality rates into age/sex-stratified infection fatality rates (IFRs). We estimated the additional risk of death in cancer patients and in those receiving chemotherapy. We illustrate the impact of these by considering the impact on a national incident cancer cohort and analyse the risk-benefit in some clinical scenarios.
We obtained data based on 412 985 cases and 41 854 deaths. The pooled estimate for IFR was 0.92%. IFRs for patients with cancer ranged from 0 to 29% and were higher in patients receiving chemotherapy (0.01-46%). The risk was significantly higher with age and in men compared with women. 37.5% of patients with a new diagnosis of cancer in 2018 had an IFR ≥5%. Survival benefits from adjuvant chemotherapy ranged from 5 to 10% in some common cancers, compared with the increased risk of death from COVID-19 of 0-3%.
Older male patients are at a higher risk of death with COVID-19. Patients with cancer are also at a higher risk, as are those who have recently received chemotherapy. We provide well-founded estimates to allow patients and clinicians to better balance these risks and illustrate the wider impact in a national incident cohort.
Clinical oncology (Royal College of Radiologists (Great Britain)). 2020 Nov 17 [Epub ahead of print]
M Williams, E Mi, K Le Calvez, J Chen, L Pakzad-Shahabi, S Dadhania, J Wang, A Ho, S Rabinowicz
Computational Oncology Group, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Radiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: ., Computational Oncology Group, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Radiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Computational Oncology Group, Department of Surgery and Cancer, Imperial College London, London, UK; Clinical Experimental Center, Jiangmen Key Laboratory of Clinical Biobanks and Translational Research, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, China; Department of Oncology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, China., Computational Oncology Group, Department of Surgery and Cancer, Imperial College London, London, UK; Brain Tumour Research Centre, Imperial College London, London, UK., Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.