Estimating the risk of death from COVID Infection in Adult Cancer Patients


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Matthew Williams, Ella Mi, Kerlann Le Calvez, Jiarong Chen, Lillie Pakzad-Shahabi, Seema Dadhania, James Wang, Andrew Ho, Simon Rabinowicz

Abstract

Background

During the COVID pandemic, guidelines have been produced for cancer patients, but none offer estimates of risk. Previous work have presented case fatality rates (CFRs) but infection fatality rates (IFRs) are more representative of true risk. This study aimed to estimate age-sex based IFRs for COVID infection and additional risk for cancer patients, compare this to benefits from chemotherapy and assess impact of COVID-associated mortality in a national cancer population.

Method

Multinational data on COVID cases and deaths was combined to generate Case Fatality Rates (CFRs), and data from closed populations was used to convert CFRs to age-sex-stratified Infection Fatality Rates (IFRs). A systematic review was conducted on risk of death for cancer patients during viral outbreaks to estimate additional risk in cancer, and chemotherapy. We assessed the impact of risk from COVID on a national incident cancer cohort and analysed risk-benefit of chemotherapy in three common cancers.

Results

412,985 cases and 41,854 deaths from COVID were included. IFR ranged from 0% in subjects <20 to 15.4% and 10.2% in males and females >90, with pooled IFR of 0.92%. 1318 cancer patients in viral outbreaks were identified to calculate an OR for death of 3.7 (95%CI 1.5- 9.1). Risk conferred by cancer during the COVID pandemic was comparable to past influenza pandemics. Estimated IFRs for COVID in cancer reach 29% and 46% in patients receiving chemotherapy, and are higher in older males. 37.5% of patients diagnosed with cancer this year have estimated IFR ≥5%, including 16% of breast, 41% of colorectal, 46% of lung and 55% of prostate cancer patients. Survival benefits from adjuvant chemotherapy were 5-10% in breast, lung and brain tumours, with increased risk of COVID death of 0-3% in worst case infection scenarios.

Conclusion

Patients with cancer and receiving chemotherapy are at higher risk of COVID death, with a significant minority of newly-diagnosed patients having risk >5%, but benefits of curative chemotherapy outweigh risks.

Impact statement

We present the first estimates of COVID-related IFR, additional risk in cancer and risk-benefit analysis for chemotherapy, based on pooled international data, to inform decision-making in cancer therapy in the context of the ongoing COVID pandemic.