Comparison of mortality in patients on chemotherapy or immunotherapy during and before the COVID-19 pandemic. Multicenter matched cohort study in Argentina




Cancer, Chemotherapy, Immunotherapy, COVID-19, Mortality, Cohort Studies


Objectives. To compare the mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. Materials and methods. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage on cytotoxic or intravenous immune therapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a cohort from a pre-pandemic period using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, severe COVID-19 complications risk, performance status, cancer and treatment type, treatment line, and body mass index. All-cause mortality was estimated in both cohorts after the 6-month follow-up. Results. Out of 169 patients recruited between April and August 2020 to the pandemic and 377 to the pre-pandemic cohorts in the same period of 2019, 168 were matched. After PSM, all-cause mortality was 17.9% in the pandemic and 18.5% in the pre-pandemic cohort, Risk Ratio: 0.97 (95% confidence interval: 0.61-1.52, p=0.888). In the pandemic cohort, 30/168 patients died - none of them from COVID-19 infection. Conclusions. We failed to demonstrate an increment in the mortality of unvaccinated, ambulatory patients on active intravenous anticancer treatment exposed to the COVID-19 pandemic.


Download data is not yet available.


World Health Organization. International Agency for Cancer Research. Latin America and The Caribbean [Internet]. [citado el 8 de enero de 2023]. Disponible en:

Alonso Araujo SE, Leal A, Yamazaki Centrone AF, Damazio Teich V, Tavares Malheiro D, Serra Cypriano A, et al. Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter. Einstein (Sao Paulo). 2021;19:eAO6282. doi: 10.31744/einstein_journal/2021AO6282.

Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7. doi: 10.1016/S1470-2045(20)30096-6.

Rakhsha A, Azghandi S, Taghizadeh-Hesary F. Decision on Chemotherapy Amidst COVID-19 Pandemic: a Review and a Practical Approach from Iran. Infect Chemother. 2020;52(4):496-502. doi: 10.3947/ic.2020.52.4.496.

Lai AG, Pasea L, Banerjee A, Denaxas S, Katsoulis M, Chang WH, et al. Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency. MedRxiv. 2020. doi: 10.1101/2020.05.27.20083287.

Atchley WT, Alvarez C, Saxena-Beem S, Schwartz TA, Ishizawar RC, Patel KP, et al. Immune Checkpoint Inhibitor-Related Pneumonitis in Lung Cancer: Real-World Incidence, Risk Factors, and Management Practices Across Six Health Care Centers in North Carolina. Chest. 2021;160(2):731-42. doi: 10.1016/j.chest.2021.02.032.

Gasparri ML, Gentilini OD, Lueftner D, Kuehn T, Kaidar-Person O, Poortmans P. Changes in breast cancer management during the Corona Virus Disease 19 pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST). Breast. 2020;52:110-5. doi: 10.1016/j.breast.2020.05.006.

de Azambuja E, Trapani D, Loibl S, Delaloge S, Senkus E, Criscitiello C, et al. ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer. ESMO Open. 2020;5(Suppl3):e000793. doi: 10.1136/esmoopen-2020-000793. 2020/01/01/;5:e000793.

Shibata Y, Murakami S, Kato T. Overview of checkpoint inhibitor pneumonitis: incidence and associated risk factors. Expert opinion on drug safety. 2021;20(5):537-47. doi: 10.1080/14740338.2021.1898584.

Lee LY, Cazier JB, Angelis V, Arnold R, Bisht V, Campton NA, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020 Jun 20;395(10241):1919-26. doi: 10.1016/S0140-6736(20)31173-9.

Rogiers A, Pires da Silva I, Tentori C, Tondini CA, Grimes JM, Trager MH, et al. Clinical impact of COVID-19 on patients with cancer treated with immune checkpoint inhibition. J Immunother Cancer. 2021;9(1):e001931. doi: 10.1136/jitc-2020-001931.

Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide? J R Soc Med. 2020;113(9):329-334. doi: 10.1177/0141076820956802.

Goldstein P, Levy Yeyati E, Sartorio L. Lockdown fatigue: The diminishing effects of quarantines on the spread of COVID-19. CID Working Paper Series. 2021.

Amin M, Edge S, Greene F, Compton CC, Gershenwald JE, Brookland RK, et al. AJCC Cancer Staging Manual. New York: Springer; 2017.

Cancer.Net [Internet]. American Society of Clinical Oncology (ASCO); 2022 [citado el 22 de junio de 2022]. Disponible en:

National Cancer Control Indicators [Internet]. Australia; 2022 [citado el 22 de junio de 2022]. Disponible en:

Buuren S, Groothuis-Oudshoorn K, Robitzsch A, Vink G, Doove L, Jolani S. Multivariate imputation by chained equations. Comprehensive R Archive. 2019;587.

Zhao Q-Y, Luo J-C, Su Y, Zhang Y-J, Tu G-W, Luo Z. Propensity score matching with R: conventional methods and new features. Ann Transl Med. 2021;9(9):812. doi: 10.21037/atm-20-3998.

Carré B. Graphs and networks: Oxford University Press, USA; 1979. 20. Johnsen E, LR Ford, DR Fulkerson: Flows in Networks. Princeton University Press, Princeton, NJ; 1962.

Gu XS, Rosenbaum PR. Comparison of multivariate matching methods: Structures, distances, and algorithms. Journal of Computational and Graphical Statistics. 1993;2(4):405-20.

Stuart EA, King G, Imai K, Ho D. MatchIt: nonparametric preprocessing for parametric causal inference. Journal of statistical software; 2011.

Jee J, Foote MB, Lumish M, Stonestrom AJ, Wills B, Narendra V, et al. Chemotherapy and COVID-19 Outcomes in Patients With Cancer. J Clin Oncol. 2020;38(30):3538-3546. doi: 10.1200/JCO.20.01307.

Russell B, Moss CL, Shah V, Ko TK, Palmer K, Sylva R, et al. Risk of COVID-19 death in cancer patients: an analysis from Guy’s Cancer Centre and King’s College Hospital in London. Br J Cancer. 2021;125(7):939-947. doi: 10.1038/s41416-021-01500-z.

Wang Q, Berger NA, Xu R. Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection. JAMA Oncol. 2021;7(2):220-227. doi: 10.1001/jamaoncol.2020.6178.

Yekedüz E, Utkan G, Ürün Y. A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19. ur J Cancer. 2020;141:92-104. doi: 10.1016/j.ejca.2020.09.028.

Park R, Lee SA, Kim SY, de Melo AC, Kasi A. Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data. Acta Oncol. 2021;60(1):13-19. doi: 10.1080/0284186X.2020.

Liu Y, Liu S, Qin Y, Zhao L, Li Y, Zhou C, et al. Does prior exposure to immune checkpoint inhibitors treatment affect incidence and mortality of COVID-19 among the cancer patients: The systematic review and meta-analysis. Int Immunopharmacol. 2021;101(Pt A):108242. doi: 10.1016/j.intimp.2021.108242.

Lin Z, Chen J, Han S. Impact of anti-cancer therapy on disease severity and mortality in cancer patients with COVID-19: a systematic review and meta-analysis. Expert Rev Anticancer Ther. 2021;21(9):1055-1066. doi: 10.1080/14737140.2021.1927721.

Russell B, Moss C, Tsotra E, Gousis C, Josephs D, Enting D, et al. The Impact of COVID-19 on the Delivery of Systemic Anti-Cancer Treatment at Guy’s Cancer Centre. (Basel). 2022;14(2):266. doi: 10.3390/cancers14020266.

University JH. Coronavirus (COVID-19). Argentina. Vizualizacions. Casos. 15 de abril 2020 - 26 de febrero 2021 [Internet]. [citado el 29 de octubre de 2022]. Disponible en:

Lau H, Khosrawipour T, Kocbach P, Ichii H, Bania J, Khosrawipour V. Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters. Pulmonology. 2021;27(2):110-115. doi: 10.1016/j.pulmoe.2020.05.015.





Original Article

How to Cite

Itkin B, Cáceres H, Onassis M, García AE, Avanzi L, Kaminszczik L, et al. Comparison of mortality in patients on chemotherapy or immunotherapy during and before the COVID-19 pandemic. Multicenter matched cohort study in Argentina. Rev Peru Med Exp Salud Publica [Internet]. 2023 Jun. 30 [cited 2024 May 27];40(2):161-9. Available from:

Most read articles by the same author(s)