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
Affiliations
- Gayathri Nagaraj
- ORCiD
- Loma Linda University Cancer Center, Loma Linda, United States
- Shaveta Vinayak
- Fred Hutchinson Cancer Research Center, Seattle, United States; University of Washington, Seattle, United States; Seattle Cancer Care Alliance, Seattle, United States
- Ali Raza Khaki
- Stanford University, Palo Alto, United States
- Tianyi Sun
- ORCiD
- Vanderbilt University Medical Center, Nashville, United States
- Nicole M Kuderer
- University of Washington, Seattle, United States; Advanced Cancer Research Group, Kirkland, United States
- David M Aboulafia
- Virginia Mason Cancer Institute, Seattle, United States
- Jared D Acoba
- University of Hawaii Cancer Center, Honolulu, United States
- Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, United States
- Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, United States
- Nicole B Balmaceda
- The University of Kansas Cancer Center, Kansas City, United States
- Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, United States
- Babar Bashir
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University, Philadelphia, United States
- Stephanie Berg
- Loyola University Medical Center, Maywood, United States
- Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, United States
- Poorva Bindal
- Beth Israel Deaconess Medical Center, Boston, United States
- Sibel Blau
- Northwest Medical Specialties, Tacoma, United States
- Brianne E Bodin
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, United States
- Hala T Borno
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, United States
- Cecilia Castellano
- Winship Cancer Institute, Emory University, Atlanta, United States
- Horyun Choi
- University of Hawaii Cancer Center, Honolulu, United States
- John Deeken
- Inova Schar Cancer Institute, Fairfax, United States
- Aakash Desai
- Mayo Clinic, Rochester, United States
- Natasha Edwin
- ThedaCare Cancer Care, Appleton, United States
- Lawrence E Feldman
- University of Illinois Hospital & Health Sciences System, Chicago, United States
- Daniel B Flora
- St. Elizabeth Healthcare, Edgewood, United States
- Christopher R Friese
- Rogel Cancer Center, University of Michigan-Ann Arbor, Ann Arbor, United States
- Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, United States
- Cyndi J Gonzalez
- Rogel Cancer Center, University of Michigan-Ann Arbor, Ann Arbor, United States
- Petros Grivas
- Fred Hutchinson Cancer Research Center, Seattle, United States; University of Washington, Seattle, United States; Seattle Cancer Care Alliance, Seattle, United States
- Shilpa Gupta
- Cleveland Clinic, Cleveland, United States
- Marcy Haynam
- The Ohio State University Comprehensive Cancer Center, Columbus, United States
- Hannah Heilman
- University of Cincinnati Cancer Center, Cincinnati, United States
- Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, United States
- Clara Hwang
- ORCiD
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, United States
- Chinmay Jani
- Mount Auburn Hospital, Cambridge, United States
- Sachin R Jhawar
- The Ohio State University Comprehensive Cancer Center, Columbus, United States
- Monika Joshi
- Penn State Health St Joseph Cancer Center, Reading, United States
- Virginia Kaklamani
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, United States
- Elizabeth J Klein
- Lifespan Cancer Institute, Brown University, Providence, United States
- Natalie Knox
- Stritch School of Medicine, Loyola University, Maywood, United States
- Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, United States
- Amit A Kulkarni
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
- Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, United States
- Chris Labaki
- Dana-Farber Cancer Institute, Boston, United States
- Philip E Lammers
- Baptist Cancer Center, Memphis, United States
- Kate I Lathrop
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, United States
- Mark A Lewis
- Intermountain Healthcare, Salt Lake City, United States
- Xuanyi Li
- Vanderbilt University Medical Center, Nashville, United States
- Gilbert de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, United States
- Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, United States; University of Washington, Seattle, United States; Seattle Cancer Care Alliance, Seattle, United States
- Della F Makower
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States
- Abdul-Hai Mansoor
- Kaiser Permanente Northwest, Portland, United States
- Merry-Jennifer Markham
- Division of Hematology and Oncology, University of Florida Health Cancer Center, Gainesville, United States
- Sandeep H Mashru
- Kaiser Permanente Northwest, Portland, United States
- Rana R McKay
- Moores Cancer Center, University of California, San Diego, San Diego, United States
- Ian Messing
- Division of Radiation Oncology, George Washington University, Washington, United States
- Vasil Mico
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University, Philadelphia, United States
- Rajani Nadkarni
- Hartford HealthCare Cancer Institute, Hartford, United States
- Swathi Namburi
- Northwest Medical Specialties, Tacoma, United States
- Ryan H Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, United States
- Taylor Kristian Nonato
- Moores Cancer Center, University of California, San Diego, San Diego, United States
- Tracey Lynn O'Connor
- Roswell Park Comprehensive Cancer Center, Buffalo, United States
- Orestis A Panagiotou
- Lifespan Cancer Institute, Brown University, Providence, United States
- Kyu Park
- Loma Linda University Cancer Center, Loma Linda, United States
- Jaymin M Patel
- Beth Israel Deaconess Medical Center, Boston, United States
- Kanishka GopikaBimal Patel
- UC Davis Comprehensive Cancer Center, University of California, Davis, Davis, United States
- Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, United States
- Hyma Polimera
- Penn State Health St Joseph Cancer Center, Reading, United States
- Matthew Puc
- ORCiD
- Virtua Health, Marlton, United States
- Yuan James Rao
- Division of Radiation Oncology, George Washington University, Washington, United States
- Pedram Razavi
- Moores Cancer Center, University of California, San Diego, San Diego, United States
- Sonya A Reid
- Vanderbilt University Medical Center, Nashville, United States
- Jonathan W Riess
- UC Davis Comprehensive Cancer Center, University of California, Davis, Davis, United States
- Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, United States
- Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, United States
- Suzanne J Rose
- Carl & Dorothy Bennett Cancer Center, Stamford Hospital, Stamford, United States
- Atlantis D Russ
- Division of Hematology and Oncology, University of Florida Health Cancer Center, Gainesville, United States
- Lidia Schapira
- Stanford University, Palo Alto, United States
- Pankil K Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, United States
- M Kelly Shanahan
- METAvivor, Annapolis, United States
- Lauren C Shapiro
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States
- Melissa Smits
- ThedaCare Cancer Care, Appleton, United States
- Daniel G Stover
- The Ohio State University Comprehensive Cancer Center, Columbus, United States
- Mitrianna Streckfuss
- Aurora Cancer Care, Advocate Aurora Health, Milwaukee, United States
- Lisa Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, United States; University of Washington, Seattle, United States; Seattle Cancer Care Alliance, Seattle, United States
- Michael A Thompson
- Aurora Cancer Care, Advocate Aurora Health, Milwaukee, United States
- Sara M Tolaney
- Dana-Farber Cancer Institute, Boston, United States
- Lisa B Weissmann
- Mount Auburn Hospital, Cambridge, United States
- Grace Wilson
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
- Michael T Wotman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, United States
- Elizabeth M Wulff-Burchfield
- The University of Kansas Cancer Center, Kansas City, United States
- Sanjay Mishra
- ORCiD
- Vanderbilt University Medical Center, Nashville, United States
- Benjamin French
- Vanderbilt University Medical Center, Nashville, United States
- Jeremy L Warner
- Vanderbilt University Medical Center, Nashville, United States
- Maryam B Lustberg
- Yale Cancer Center, Yale University School of Medicine, New Haven, United States
- Melissa K Accordino
- ORCiD
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, United States
- Dimpy P Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, United States
- On behalf of the COVID-19 and Cancer Consortium
- DOI
- https://doi.org/10.7554/eLife.82618
- Journal volume & issue
-
Vol. 12
Abstract
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.
Keywords