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, Loma Linda University Cancer Center, Loma Linda, United States.
Shaveta Vinayak, Fred Hutchinson Cancer Research Center, Seattle, United States.
Ali Raza Khaki, Stanford University, Palo Alto, United States.
Tianyi Sun, Vanderbilt University Medical Center, Nashville, United States.
Nicole M. Kuderer, University of Washington, Seattle, 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.
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.

Document Type

Journal Article

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


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.