ABSTRACT
Background: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and a diagnosis of cancer are at high risk of severe symptomatic disease (COVID-19) and death. We performed a systematic review and meta-analysis of published studies, to estimate the case-fatality rate (CFR) of patients with solid or hematological tumors and SARS-CoV-2 infection. Methods: A systematic search of PubMed library up to 31 January, 2021, was performed in order to identify publications reporting the CFR among adult patients with solid or hematological tumors and SARS-CoV-2 infection. CFR was defined as the rate of deaths among SARS-CoV-2-positive cancer patients. Moreover, we separately assessed the CFR among patients with lung and breast cancer. Studies with at least 10 patients were included. The CFR was assessed through a random effect model, and 95% confidence intervals (CI) were calculated. The Higgins I2 index was computed to assess the heterogeneity between studies. Results: The systematic search of the literaturereturned 1,727studies. 1,551 were excluded on the basis of the title, 29 based on the abstract, and 3 were duplicates. A total of 144 studies were selected, including 35,725 patients with solid or hematological tumors and SARS-CoV-2 infection. In total, 46 and 32 studies reported the CFR among COVID-19 patients with lung (total N = 1,555) and breast (total N = 1.398) cancer, respectively. Overall, the CFR was 25.5% (95% CI 23.1%-28.1%, Egger test p < 0.001). A sensitivity analysis, after excluding studies with less than 100 patients, showed a CFR of 22.1% (95% CI 19.4%-25.2%). The CFR among patients with lung cancer and SARSCoV2 infection was 33.4% (95% CI 28.1%-39.6%) when including all studies and 26.3% (95% CI 17.6%-39.2%) at the sensitivity analysis after excluding studies with less than 100 patients. The CFR among patients with breast cancer and SARS-CoV2 infection was 13.7% (95% CI 9.1%-20.7%) when including all studies and 13.0% (95% CI 7.6%-22.1%) at the sensitivity analysis after excluding studies with less than 100 patients. Conclusions: One year after the outbreak of the pandemic, this large metaanalysis reports the impact of SARS-CoV-2 infection in patients with cancer. This population experienced a high probability of mortality, with a comparatively higher CFR in patients with lung cancer, and a comparatively lower CFR in patients with breast cancer. Patients with an underlying diagnosis of cancer require special attention with aggressive preventive measures that also include early access to COVID-19 vaccination.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) outbreak is changing the approach of medical oncologists to cancer management. However, the real impact on cancer care and its potential negative consequences are currently unknown. Methods: A 29-multiple choice question anonymous online survey was shared with members of the Italian Association of Medical Oncology and the Gruppo Italiano Mammella on April 3, 2020. The objectives of the survey were to investigate the attitudes and practice of Italian oncologists before and during COVID-19 outbreak on three relevant areas in breast cancer care: 1) (neo)adjuvant setting;2) metastatic setting;3) research activities. Results: The survey was completed by 165 oncologists, of whom 121 (73.3.%) worked in Breast Units. In the (neo) adjuvant setting, compared to before the emergency, a lower rate of oncologists adopted during COVID-19 outbreak weekly paclitaxel (68.5% vs. 93.9%, P<.001) and dose-dense schedule for anthracycline-based chemotherapy (43% vs. 58.8%, P<.001). In the metastatic setting, compared to before the emergency, a lower number of oncologists adopted during COVID-19 outbreak first-line weekly paclitaxel for HER2-positive disease (41.8% vs. 53.9%, P=.002) or CDK4/6 inhibitors for luminal tumors with less aggressive characteristics (55.8% vs. 80.0%, P<.001). A significant change was also observed in terms of delaying the timing for monitoring CDK4/6 inhibitors therapy, assessing treatment response with imaging and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously involved in these activities, respectively. Conclusions: Most of the changes in the attitudes and practice of Italian oncologists were reasonable responses to the current health emergency without expected major negative impact on patients' outcomes, although some potentially alarming signals of undertreatment were observed. These data invite developing cautious recommendations to help oncologists ensuring continuous effective and safe cancer care.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) outbreak is changing the approach of medical oncologists to cancer management. However, the real impact on cancer care and its potential negative consequences are currently unknown. Methods: A 29-multiple choice question anonymous online survey was shared with members of the Italian Association of Medical Oncology and the Italian Breast Cancer Study Group on April 3, 2020. The objectives of the survey were to investigate the attitudes and practice of Italian oncologists before and during COVID-19 outbreak on three relevant areas in breast cancer care: 1) (neo)adjuvant setting;2) metastatic setting;3) research activities. Results: The survey was completed by 165 oncologists, of whom 121 (73.3.%) worked in Breast Units. In the (neo)adjuvant setting, compared to before the emergency, a lower rate of oncologists adopted during COVID-19 outbreak weekly paclitaxel (68.5% vs. 93.9%, P<.001) and dose-dense schedule for anthracycline-based chemotherapy (43% vs. 58.8%, P<.001). In the metastatic setting, compared to before the emergency, a lower number of oncologists adopted during COVID-19 outbreak first-line weekly paclitaxel for HER2-positive disease (41.8% vs. 53.9%, P=.002) or CDK4/6 inhibitors for luminal tumors with less aggressive characteristics (55.8% vs. 80.0%, P<.001). A significant change was also observed in terms of delaying the timing for monitoring CDK4/6 inhibitors therapy, assessing treatment response with imaging and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously involved in these activities, respectively. Conclusions: Most of the changes in the attitudes and practice of Italian oncologists were reasonable responses to the current health emergency without expected major negative impact on patients’ outcomes, although some potentially alarming signals of undertreatment were observed. These data invite developing cautious recommendations to help oncologists ensuring continuous effective and safe cancer care. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: F. Poggio: Travel/Accommodation/Expenses: Takeda;Honoraria (self), Travel/Accommodation/Expenses: Ely Lilly;Honoraria (self): Merck Sharp & Dohme;Novartis. M. Tagliamento: Travel/Accommodation/Expenses: Roche;Bristol-Myers Squibb;AstraZeneca;Takeda;Honoraria (self): Novartis. M. Di Maio: Research grant/Funding (institution): Tesaro GSK;Honoraria (self), Advisory/Consultancy: AstraZeneca;Janssen;Astellas;Eisai;Pfizer;Merck Sharp & Dohme;Takeda. L. Del Mastro: Advisory/Consultancy: Roche;Novartis;Eisai;Pfizer;AstraZeneca;Ipsen;Eli Lilly;MSD;Seattle Genetics;Genomic Health. M. Lambertini: Advisory/Consultancy: Roche;Honoraria (self): Theramex, Eli Lilly. All other authors have declared no conflicts of interest.