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, Henry Ford HealthFollow
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

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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, NCT04354701.

Medical Subject Headings

United States; Humans; Female; Middle Aged; COVID-19; SARS-CoV-2; Cohort Studies; Breast Neoplasms; Retrospective Studies

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