Abstract

BACKGROUND: Cancer is considered to be an independent risk factor for severe illness and higher mortality in patients with Coronavirus disease 2019 (COVID-19). These adverse outcomes have been suspected to be more severe in lung cancer patients. The objective of this systematic review and meta-analysis is to outline patient characteristics, challenges in diagnosis and treatment, and outcomes of lung cancer patients with COVID-19. METHODS: A comprehensive search was conducted using EMBASE and PUBMED databases using the terms "COVID" and "cancer." Studies that reported clinical characteristics and/or outcomes of lung cancer patients with COVID-19 were then systematically identified. Meta-analysis for COVID-19 related mortality associated with lung cancer compared to other cancer types was conducted. The results were reported as odds ratio (OR) and confidence intervals (CI) using mixed-effects logistic regression model. RESULTS: The most commonly reported clinical findings in lung cancer patients with COVID-19 were fever and cough, with 68% and 61%, respectively. Laboratory and radiographic findings were consistent with broadly reported data. The meta-analysis noted a statistically significant increase in mortality rate in lung cancer patients compared to other cancer patients, OR 1.62 (95% CI: 1.06-2.48). Lung cancer patients with COVID-19 also reflected greater severity of illness and higher rates of ICU admissions and mechanical ventilation. CONCLUSIONS: COVID-19 in lung cancer patients is associated with severe disease and increased mortality relative to patients with other malignancies and the general population. There is conflicting evidence on the effect of specific lung cancer treatments on outcomes. Until more definitive data is available, lung cancer directed treatment should be continued or restarted as early as possible in mild to moderate cases to prevent worsening cancer-related mortality.
All age groups Risk factor COVID-19