Author: 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.
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 .