학술논문
Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study
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article
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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; Lopes, Gilbert de Lima; 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; Shah, Dimpy P
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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.