Abstract PO-085: Sex bias in COVID-19-associated Illness severity and mortality in cancer patients: A systematic review and meta-analysis
Authors: Park Robin , Chidharla Anusha , Mehta Kathan , Sun Weijing , Kasi Anup 
Published: December 2020

Abstract
Importance: There is strong evidence that COVID-19 is associated with higher morbidity and mortality in males compared to females in the general population. However, whether the same sex bias exists in the cancer patient population is unknown. Several published studies have examined this question, but the results are inconclusive and inconsistent and the association remains unclear.
Objective: To evaluate the sex differences in the risk of severe illness and mortality attributable to COVID-19 in the cancer patient population.
Data Sources: Published articles that evaluated clinical outcomes associated with severe illness or death attributable to COVID-19 in the cancer patient population from inception to June 1, 2020, were identified by searching PubMed and EMBASE, as well as the ASCO 2020 Virtual Annual Conference, ESMO conferences held from January 2020 to June 1, 2020, and the preprint databases medRxiv and bioRxiv.
Study Selection: Prospective or retrospective analyses, studies published in English, providing clinical outcomes data with sex differences in the cancer patient population.
Data Extraction and Synthesis: Author, date of publication, country, type of studies, median and range of age, cancer types included in the studies, definitions of clinical outcomes, and the odds ratios (OR) for severe illness or death attributable to COVID-19 were retrieved. Where OR data were not available, raw data were used to calculate the OR in a univariate analysis model and included in the meta-analysis.
Main Outcome(s) and Measure(s): The primary outcome of interest was OR of (1) severe illness, (2) death, and (3) composite outcome of severe illness and death attributable to COVID-19 in males versus females.
Results: Overall, 2,764 patients (9 studies) were analyzed in retrospective study settings. Of the included studies, two studies were multinational whereas the rest were conducted in China (4), France (1), United Kingdom (1), and United States (1). Median ages were similar across studies (range 62-70). Three studies reported outcomes for death and six studies reported outcomes for severe illness. Of the seven studies, all but one defined severe illness as illness requiring ICU admission or leading to death and attributable to COVID-19. Pooled ORs for the composite outcome was 1.68 (95% CI, 1.27-2.24), death was 1.98 (95% CI, 1.21-3.26), and severe illness was 1.48 (95% CI, 1.05-2.10), all disfavoring males. Random effects model was used with the Dersimonian-Laird Model throughout analyses and significant heterogeneity was subsequently confirmed (I2, 48.1%; tau2, 0.0816). No significant between-study bias was detected per Begg’s funnel plot.
Conclusions and Relevance: The male sex was associated with higher risk of severe illness, death, and the composite outcome of both attributable to COVID-19. This finding has implications in informing the clinical prognosis and decision making regarding oncologic patients.
Citation Format: Robin Park, Anusha Chidharla, Kathan Mehta, Weijing Sun, Anup Kasi. Sex bias in COVID-19-associated Illness severity and mortality in cancer patients: A systematic review and meta-analysis [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-085.