Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

• Published in: medRxiv : the preprint server for health sciences
• Main 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
• Format: Journal Article
• Language: English
• Published: United States 10.03.2023
• Subjects: COVID-19; SARS-CoV-2; Risk Factors; Oncology; Pandemic; Breast cancer; Racial Inequities

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