Covid-19 and Cancer Consortium (CCC19) breast cancer and racial disparities outcomes study

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 were 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.