eLife (Oct 2023)

Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study

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

DOI
https://doi.org/10.7554/eLife.82618
Journal volume & issue
Vol. 12

Abstract

Read online

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.

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