1. Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study
- Author
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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, Gilbert, 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, and Shah, Dimpy P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Coronaviruses ,Infectious Diseases ,Cancer ,Emerging Infectious Diseases ,Breast Cancer ,Lung ,Women's Health ,Good Health and Well Being ,United States ,Humans ,Female ,Middle Aged ,COVID-19 ,SARS-CoV-2 ,Cohort Studies ,Breast Neoplasms ,Retrospective Studies ,COVID-19 and Cancer Consortium ,breast cancer ,epidemiology ,global health ,human ,oncology ,pandemic ,racial inequities ,Biochemistry and Cell Biology ,Biological sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundLimited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations.MethodsThis 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.Results1383 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.ConclusionsUsing 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.FundingThis 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 numberCCC19 registry is registered on ClinicalTrials.gov, NCT04354701.
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- 2023