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 , Lopes Gilbert de Lima , 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 ,   On behalf of the COVID-19 and Cancer Consortium
Published: October 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:

1383 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; KL2 TR002646 for Pankil 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.