Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8441-8452
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8441
Clinical considerations for critically ill COVID-19 cancer patients: A systematic review
Chidambaram Ramasamy, Ajay Kumar Mishra, Kevin John John, Amos Lal
Chidambaram Ramasamy, Ajay Kumar Mishra, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Kevin John John, Department of Medicine, Bangalore Baptist Hospital, Bangalore 578954, India
Amos Lal, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
Author contributions: Ramasamy C, Mishra AK and John KJ drafted the primary manuscript; Ramasamy C, Mishra AK, John KJ and Lal A searched literature and took part in the revision; and Lal A reviewed.
Conflict-of-interest statement: All authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, manuscript was prepared and revised according to the PRISMA 2009 Checklist. Attached with the current submission.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Amos Lal, FACP, MBBS, Doctor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55902, United States.
Received: February 18, 2021
Peer-review started: February 18, 2021
First decision: April 6, 2021
Revised: April 7, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 6, 2021
Research background

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 has led to an unprecedented global public health crisis. Patients with cancers are particularly suspectable to morbidity and mortality from COVID-19 infection due to their medical risk factors, immune dysfunction, and frequent health care visits for their underlying disease.

Research motivation

To analyze the characteristics of COVID-19 infection among cancer patients which would help treating physicians in optimal management of COVID-19 cancer patients.

Research objectives

In this review article, authors intend to describe the role of critical care in COVID-19 cancer patients and to analyze the various factors which determine the outcome in patients with malignancy and COVID-19.

Research methods

Authors searched the PubMed and, Medline database for “COVID-19” and “Cancer”, “Malignancy”. Studies published in English, including adults with malignancy and COVID-19 infection, were eligible to be included in this review. We identified two thousand one hundred eighty-six articles, among which eighteen studies were eligible and were included in this review.

Research results

A total of 5199 cancer patients were reported. Male predominance was noted in 12 studies. Most reported malignancies with COVID-19 infection were hematological in 44% of patients, followed by thoracic malignancy in 11% of patients. The mean number of cancer patients with COVID-19 requiring critical care was 16%. The mean mortality reported was 27.4%. 72% of COVID-19 cancer patients required hospitalization across all the studies. Majority of the cancer patients required intensive care due to respiratory failure and the need for mechanical ventilation. Male gender, age ≥ 65 years, presence of higher comorbidity burden and smoking history are associated with the worse outcome from COVID-19 infections among the cancer patients. These factors are significantly associated with the patient’s worse outcome independent of oncological features such as tumor stage, disease status, or current provision of active anticancer therapy.

Research conclusions

Among symptomatic COVID-19 cancer patients, approximately one in six patients required intensive level of care, and one in four patients had a fatal outcome. It is crucial to identify factors associated with the worse outcome as it helps to provide prognostic enrichment while discussing the goals of care in this specific patient population. Appropriate contingency planning for these patients in terms of goals of care and judicious resource allocation in the resource-poor regions is the key.

Research perspectives

In this review, we identified that in the setting of active malignancy cytotoxic treatments can be continued with caution. Cancer patients treated with tyrosine kinase inhibitors were less likely to develop severe forms of COVID-19 infection. Two randomized control trials are ongoing to provide more definitive evidence.