Significant heterogeneity has been identified at risk of coronavirus disease 2019 (COVID-19) – associated mortality in patients based on factors such as cancer subtype, age, sex, and patient proportion, according to a complete meta-analysis from the Reboot: COVID -Cancer Project.
In a presentation on the findings of the study at the AACR Virtual Meeting 2021 on COVID-19 and cancer, researchers identified a higher risk of COVID-19-related death in patients with hematologic malignancy versus severe malignancies.
Among patients with hematologic malignancy, COVID-19-related death was more likely to occur in those with bone marrow failure syndromes followed by acute myeloid leukemia, plasma cell dyscrasias, mature B-cell lymphomas and neoplasms, and lymphoblastic leukemia acute. Moreover, among patients with severe malignancy, COVID-19-related death was more likely to occur in patients with lung and then prostate cancer; central nervous / brain system; colorectal; bone, soft, and pleural sarcomas; gynecologic; skin; and breast cancers.
“We conducted meta-analyzes to better understand the difference between hematologic and severe malignancies in terms of risk of death,” said Catherine Del Vecchio Fitz, MS, PhD, co-founder and chief scientific officer at Reboot Rx, during the exhibition. “There were 6 studies with approximately 4900 patients with both severe malignancy and hematologic malignancy reported internally. By comparing them, we found a significantly greater risk of death in hematologic malignancies compared with severe malignancies. “
In addition, the meta-analysis showed that 25% (95% CI, 23–28) were among the overall risk of death among cancer patients. Age, gender, and percentage in hospital were other factors associated with a higher risk of death. Studies involving patients of middle age over 65 had a 31% risk of death compared to 17% in studies with a middle age below 65. Studies with a male population greater than 65 had a 31% risk of death. 55% compared with mortality to studies with less than 55% male population (19%). Finally, studies where more than 80% of patients were hospitalized had a 31% risk of death, and a hospital mortality rate of 50% -80% had a 24% risk of death and a hospital mortality rate of less than 50% with 16% risk of death.
“Studies with a higher middle age had a higher risk of death, a higher percentage of male patients, and a higher percentage of hospital patients compared to studies with a lower middle age, less male patients, or a lower percentage of hospitalized patients. ”Del Vecchio Fitz said.
The rationale for the Cancer Reboot Project: COVID-19, which is a living resource with complete data on COVID-19 and cancer, was inspired by the increased risk of mortality faced by cancer patients, as well as lack of comprehensive resources that can be used to gather and collate evidence on a regular basis. The project collected data on COVID-19-related mortality in 22 different cancer subtypes. The aims of the project are to help accelerate COVID-19 research, as well as help inform decisions.
Analysts drew data from 270 published clinical studies and 162 registered clinical trials with a focus on COVID-19 and patients with cancer to study overall mortality. To collect data, researchers began by examining more than 90,000 published COVID-19-related published studies.
“Using targeted research questions, we were able to narrow this down to approximately 40,000 articles that we thought were clinically relevant,” Del Vecchio Fitz explained. “We used more questioning along with some rules-based approaches to narrow down to around 3000 articles involving cancer. However, many of these did not report results for COVID-19, so we used additional rules with a lot of manual validation to pull out a set of studies that reported mortality outcomes, particularly across patients with cancer and COVID-19. ”
In addition, researchers compiled a second data set examining cancer-related outcomes for COVID-19 treatments, although these data were not included in the presentation.
From there, researchers built an interactive editorial board that allowed them to view the data. The dashboard provides users with information on the number of studies currently in the database along with the total number of patients admitted to the studies, and raw case mortality rates unchanged.
“We also drew a number of variables from these surveys as they became available. For example, type of study, average or average age of patients, percentage of male patients, percentage of hospitalized patients, tight subtype or cancer if available, and location of study, ”Said Del Vecchio Fitz
To select studies for the meta-analysis, analysts first identified records by database analysis (n = 3380) and other sources (n = 2). From there, investigators removed duplicate and scraped records, removing any studies that did not report outcomes on patients with COVID-19 and cancer. Subsequently, studies were reached for eligibility (n = 270), with case studies, observational studies with less than 25 patients, studies with known pediatric patients, and studies with two-fold closed patient accounts. mach. Investigators were left with 83 studies in qualitative synthesis, which included 24,144 patients with both cancer and COVID-19. A total of 24 studies were incorporated into the meta-analysis.
Additional findings examined whether patients with cancer had a higher risk of COVID-19-related death compared with patients without cancer. After selecting several internally controlled studies made up of a non-cancer group, researchers identified a high risk of death in cancer patients. In examining the effect of chemotherapy on risk of death, researchers consider 10 studies with 7700 cancer patients who reported specific chemotherapy results. Investigators maintained that treatment with chemotherapy did not result in an increased risk for COVID-19-related death.
“While we were able to perform very robust analyzes with the available data, much of the clinical data was not provided in a way to analyze subgroups, even when information such as explain that in a study, ”Del Vecchio Fitz concluded.
Information
Del Vecchio Fritz C. A complete meta-analysis of COVID-19 mortality rates for 22 cancer subtypes from the Reboot Project: COVID-Cancer, an interactive resource with total data from 21,839 cancer patients. Presented at: 2021 AACR Virtual Reality: COVID-19 and cancer; February 3-5, 2021; Virtually.