Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
Authors: Nagaraj Gayathri , Vinayak Shaveta , Khaki Ali Raza , Sun Tianyi , Kuderer Nicole M. , Aboulafia David M. , Acoba Jared D. , Awosika Joy , Bakouny Ziad , Balmaceda Nicole B. , Bao Ting , Bashir Babar , Berg Stephanie , Bilen Mehmet A. , Bindal Poorva , Blau Sibel , Bodin Brianne E. , Borno Hala T. , Castellano Cecilia , Choi Horyun , Deeken John , Desai Aakash , Edwin Natasha , Feldman Lawrence E. , Flora Daniel B. , Friese Christopher R. , Galsky Matthew D. , Gonzalez Cyndi J. , Grivas Petros , Gupta Shilpa , Haynam Marcy , Heilman Hannah , Hershman Dawn L. , Hwang Clara , Jani Chinmay , Jhawar Sachin R. , Joshi Monika , Kaklamani Virginia , Klein Elizabeth J. , Knox Natalie , Koshkin Vadim S. , Kulkarni Amit A. , Kwon Daniel H. , Labaki Chris , Lammers Philip E. , Lathrop Kate I. , Lewis Mark A. , Li Xuanyi , de Lima Lopes Gilberto , Lyman Gary H. , Makower Della F. , Mansoor Abdul-Hai , Markham Merry-Jennifer , Mashru Sandeep H. , McKay Rana R. , Messing Ian , Mico Vasil , Nadkarni Rajani , Namburi Swathi , Nguyen Ryan H. , Nonato Taylor Kristian , O’Connor Tracey Lynn , Panagiotou Orestis A. , Park Kyu , Patel Jaymin M. , Patel Kanishka GopikaBimal , Peppercorn Jeffrey , Polimera Hyma , Puc Matthew , Rao Yuan James , Razavi Pedram , Reid Sonya A. , Riess Jonathan W. , Rivera Donna R. , Robson Mark , Rose Suzanne J. , Russ Atlantis D. , Schapira Lidia , Shah Pankil K. , Shanahan M. Kelly , Shapiro Lauren C. , Smits Melissa , Stover Daniel G. , Streckfuss Mitrianna , Tachiki Lisa , Thompson Michael A. , Tolaney Sara M. , Weissmann Lisa B. , Wilson Grace , Wotman Michael T. , Wulff-Burchfield Elizabeth M. , Mishra Sanjay , French Benjamin , Warner Jeremy L. , Lustberg Maryam B. , Accordino Melissa K. , Shah Dimpy P. 
Published: March 2023

Background

Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations.

Methods

This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity.

Results

1,383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32 – 1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70 – 6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83 – 12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63 – 3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20 – 2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66 – 3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89 – 22.6]). Hispanic ethnicity, timing and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status.

Conclusions

Using one of the largest registries on cancer and COVID-19, we identified patient and BC related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to Non-Hispanic White patients.

Funding

This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L. Warner; P30-CA046592 to Christopher R. Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K. Shah and Dimpy P. Shah; and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P. Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication.

Clinical Trial Number

CCC19 registry is registered on ClinicalTrials.gov,NCT04354701.