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. 2023 Oct 17:12:e82618.
doi: 10.7554/eLife.82618.

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  1 , Shaveta Vinayak  2   3   4 , Ali Raza Khaki  5 , Tianyi Sun  6 , Nicole M Kuderer  3   7 , David M Aboulafia  8 , Jared D Acoba  9 , Joy Awosika  10 , Ziad Bakouny  11 , Nicole B Balmaceda  12 , Ting Bao  13 , Babar Bashir  14 , Stephanie Berg  15 , Mehmet A Bilen  16 , Poorva Bindal  17 , Sibel Blau  18 , Brianne E Bodin  19 , Hala T Borno  20 , Cecilia Castellano  16 , Horyun Choi  9 , John Deeken  21 , Aakash Desai  22 , Natasha Edwin  23 , Lawrence E Feldman  24 , Daniel B Flora  25 , Christopher R Friese  26 , Matthew D Galsky  27 , Cyndi J Gonzalez  26 , Petros Grivas  2   3   4 , Shilpa Gupta  28 , Marcy Haynam  29 , Hannah Heilman  10 , Dawn L Hershman  19 , Clara Hwang  30 , Chinmay Jani  31 , Sachin R Jhawar  29 , Monika Joshi  32 , Virginia Kaklamani  33 , Elizabeth J Klein  34 , Natalie Knox  35 , Vadim S Koshkin  20 , Amit A Kulkarni  36 , Daniel H Kwon  20 , Chris Labaki  11 , Philip E Lammers  37 , Kate I Lathrop  33 , Mark A Lewis  38 , Xuanyi Li  6 , Gilbert de Lima Lopes  39 , Gary H Lyman  2   3   4 , Della F Makower  40 , Abdul-Hai Mansoor  41 , Merry-Jennifer Markham  42 , Sandeep H Mashru  41 , Rana R McKay  43 , Ian Messing  44 , Vasil Mico  14 , Rajani Nadkarni  45 , Swathi Namburi  18 , Ryan H Nguyen  24 , Taylor Kristian Nonato  43 , Tracey Lynn O'Connor  46 , Orestis A Panagiotou  34 , Kyu Park  1 , Jaymin M Patel  17 , Kanishka GopikaBimal Patel  47 , Jeffrey Peppercorn  48 , Hyma Polimera  32 , Matthew Puc  49 , Yuan James Rao  44 , Pedram Razavi  43 , Sonya A Reid  6 , Jonathan W Riess  47 , Donna R Rivera  50 , Mark Robson  13 , Suzanne J Rose  51 , Atlantis D Russ  42 , Lidia Schapira  5 , Pankil K Shah  33 , M Kelly Shanahan  52 , Lauren C Shapiro  40 , Melissa Smits  23 , Daniel G Stover  29 , Mitrianna Streckfuss  53 , Lisa Tachiki  2   3   4 , Michael A Thompson  53 , Sara M Tolaney  11 , Lisa B Weissmann  31 , Grace Wilson  36 , Michael T Wotman  27 , Elizabeth M Wulff-Burchfield  12 , Sanjay Mishra  6 , Benjamin French  6 , Jeremy L Warner  6 , Maryam B Lustberg  54 , Melissa K Accordino  19 , Dimpy P Shah  33 ; COVID-19 and Cancer Consortium
Collaborators, Affiliations

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 et al. Elife. .

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: COVID-19; SARS-CoV-2; breast cancer; epidemiology; global health; human; oncology; pandemic; racial inequities.

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Conflict of interest statement

GN, SV, AK, TS, NK, DA, JA, JA, ZB, NB, TB, BB, SB, MB, PB, SB, BB, HB, CC, HC, JD, AD, NE, LF, DF, CF, MG, CG, PG, SG, MH, HH, DH, CH, CJ, SJ, MJ, VK, EK, NK, VK, AK, DK, CL, PL, KL, ML, XL, GL, GL, DM, AM, MM, SM, RM, IM, VM, RN, SN, RN, TN, TO, OP, KP, JP, KP, JP, HP, MP, YR, PR, SR, JR, DR, MR, SR, AR, LS, PS, MS, LS, MS, DS, MS, LT, MT, ST, LW, GW, MW, EW, SM, BF, JW, ML, MA, DS No competing interests declared

Figures

Figure 1.
Figure 1.. Consort flow diagram.
Descriptive flow chart of patients included in the study.
Appendix 4—figure 1.
Appendix 4—figure 1.. Represents graphical methods used to verify the proportional odds assumptions.
See this image and copyright information in PMC

Update of

  • Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study.
    Nagaraj G, Vinayak S, Khaki AR, Sun T, Kuderer NM, Aboulafia DM, Acoba JD, Awosika J, Bakouny Z, Balmaceda NB, Bao T, Bashir B, Berg S, Bilen MA, Bindal P, Blau S, Bodin BE, Borno HT, Castellano C, Choi H, Deeken J, Desai A, Edwin N, Feldman LE, Flora DB, Friese CR, Galsky MD, Gonzalez CJ, Grivas P, Gupta S, Haynam M, Heilman H, Hershman DL, Hwang C, Jani C, Jhawar SR, Joshi M, Kaklamani V, Klein EJ, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Labaki C, Lammers PE, Lathrop KI, Lewis MA, Li X, de Lima Lopes G, Lyman GH, Makower DF, Mansoor AH, Markham MJ, Mashru SH, McKay RR, Messing I, Mico V, Nadkarni R, Namburi S, Nguyen RH, Nonato TK, O'Connor TL, Panagiotou OA, Park K, Patel JM, Patel KG, Peppercorn J, Polimera H, Puc M, Rao YJ, Razavi P, Reid SA, Riess JW, Rivera DR, Robson M, Rose SJ, Russ AD, Schapira L, Shah PK, Shanahan MK, Shapiro LC, Smits M, Stover DG, Streckfuss M, Tachiki L, Thompson MA, Tolaney SM, Weissmann LB, Wilson G, Wotman MT, Wulff-Burchfield EM, Mishra S, French B, Warner JL, Lustberg MB, Accordino MK, Shah DP. Nagaraj G, et al. medRxiv [Preprint]. 2023 Mar 10:2023.03.09.23287038. doi: 10.1101/2023.03.09.23287038. medRxiv. 2023. Update in: Elife. 2023 Oct 17;12:e82618. doi: 10.7554/eLife.82618. PMID: 37205429 Free PMC article. Updated. Preprint.

References

    1. Albiges L, Foulon S, Bayle A, Gachot B, Pommeret F, Willekens C, Stoclin A, Merad M, Griscelli F, Lacroix L, Netzer F, Hueso T, Balleyguier C, Ammari S, Colomba E, Baciarello G, Perret A, Hollebecque A, Hadoux J, Michot J-M, Chaput N, Saada V, Hauchecorne M, Micol J-B, Sun R, Valteau-Couanet D, André F, Scotte F, Besse B, Soria J-C, Barlesi F. Determinants of the outcomes of patients with cancer infected with SARS-CoV-2: results from the Gustave Roussy cohort. Nature Cancer. 2020;1:965–975. doi: 10.1038/s43018-020-00120-5. - DOI - PubMed
    1. Azar KMJ, Shen Z, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR. Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. Health Affairs. 2020;39:1253–1262. doi: 10.1377/hlthaff.2020.00598. - DOI - PubMed
    1. Bigby J, Holmes MD. Disparities across the breast cancer continuum. Cancer Causes & Control. 2005;16:35–44. doi: 10.1007/s10552-004-1263-1. - DOI - PubMed
    1. CDC COVID Data Tracker,” Centers for Disease Control and Prevention. 2020a. [December 14, 2021]. https://covid.cdc.gov/covid-data-tracker
    1. CDC Community, Work, and School,” Centers for Disease Control and Prevention. 2020b. [October 4, 2021]. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial...

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