Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: a COVID-19 and cancer consortium (CCC19) cohort study
- Loma Linda University, United States
- Fred Hutchinson Cancer Research Center, United States
- Stanford University, United States
- Vanderbilt University Medical Center, United States
- University of Washington, United States
- Virginia Mason Institute, United States
- University of Hawaii, United States
- University of Cincinnati, United States
- Dana-Farber Cancer Institute, United States
- University of Kansas Cancer Center, United States
- Memorial Sloan Kettering Cancer Center, United States
- Thomas Jefferson University, United States
- Loyola University Medical Center, United States
- Emory University, United States
- Beth Israel Deaconess Medical Center, United States
- Northwest Medical Specialties, United States
- Columbia University, United States
- University of California, San Francisco, United States
- Inova Schar Cancer Institute, United States
- Mayo Clinic, United States
- ThedaCare, United States
- University of Illinois Hospital & Health Sciences System, United States
- St. Elizabeth Healthcare, United States
- University of Michigan-Ann Arbor, United States
- Icahn School of Medicine at Mount Sinai, United States
- Cleveland Clinic, United States
- The Ohio State University, United States
- Henry Ford Hospital, United States
- Mount Auburn Hospital, United States
- Penn State Health St Joseph Cancer Center, United States
- The University of Texas MD Anderson Cancer Center, United States
- Brown University, United States
- Loyola University, United States
- University of Minnesota, United States
- Baptist Cancer Center, United States
- Intermountain Healthcare, United States
- University of Miami, United States
- Albert Einstein College of Medicine, United States
- Kaiser Permanente Northwest, United States
- University of Florida, United States
- University of California, San Diego, United States
- George Washington University, United States
- Hartford HealthCare Cancer Institute, United States
- Roswell Park Comprehensive Cancer Center, United States
- University of California, Davis, United States
- Massachusetts General Hospital, United States
- Penn State Health St. Joseph Cancer Center, United States
- Virtua Health, United States
- National Cancer Institute, United States
- Stamford Hospital, United States
- METAvivor, United States
- ThedaCare Cancer Care, United States
- Advocate Aurora Health, United States
- Fred Hutchinson/University of Washington Cancer Consortium, United States
- Yale University, United States
Abstract
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 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; 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 ClinicalTrials.gov, NCT04354701.
Data availability
All datasets (with restriction of time variables to protect patient confidentiality) and code associated with the article are available at: https://datadryad.org/stash/dataset/doi:10.5061/dryad.1g1jwsv10
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Covid-19 and Cancer Consortium (CCC19) breast cancer and racial disparities outcomes study [Dataset]Dryad Digital Repository, doi:10.5061/dryad.1g1jwsv10.
Article and author information
Author details
Funding
National Cancer Institute (P30 CA068485)
- Tianyi Sun
- Sanjay Mishra
- Benjamin French
- Jeremy L Warner
National Cancer Institute (P30-CA046592)
- Christopher R Friese
National Cancer Institute (P30 CA023100)
- Rana R McKay
National Cancer Institute (P30-CA054174)
- Pankil K Shah
- Dimpy P Shah
American Cancer Society (MRSG-16-152-01 -CCE)
- Dimpy P Shah
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: This study was exempt from institutional review board (IRB) review (VUMC IRB#200467) and was approved by IRBs at participating sites per institutional policy. CCC19 registry is registered on ClinicalTrials.gov, NCT04354701.
Copyright
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
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Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: a COVID-19 and cancer consortium (CCC19) cohort study
eLife 12:e82618.
https://doi.org/10.7554/eLife.82618
Further reading
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- Epidemiology and Global Health
- Microbiology and Infectious Disease
Background:
In many settings, a large fraction of the population has both been vaccinated against and infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hence, quantifying the protection provided by post-infection vaccination has become critical for policy. We aimed to estimate the protective effect against SARS-CoV-2 reinfection of an additional vaccine dose after an initial Omicron variant infection.
Methods:
We report a retrospective, population-based cohort study performed in Shanghai, China, using electronic databases with information on SARS-CoV-2 infections and vaccination history. We compared reinfection incidence by post-infection vaccination status in individuals initially infected during the April–May 2022 Omicron variant surge in Shanghai and who had been vaccinated before that period. Cox models were fit to estimate adjusted hazard ratios (aHRs).
Results:
275,896 individuals were diagnosed with real-time polymerase chain reaction-confirmed SARS-CoV-2 infection in April–May 2022; 199,312/275,896 were included in analyses on the effect of a post-infection vaccine dose. Post-infection vaccination provided protection against reinfection (aHR 0.82; 95% confidence interval 0.79–0.85). For patients who had received one, two, or three vaccine doses before their first infection, hazard ratios for the post-infection vaccination effect were 0.84 (0.76–0.93), 0.87 (0.83–0.90), and 0.96 (0.74–1.23), respectively. Post-infection vaccination within 30 and 90 days before the second Omicron wave provided different degrees of protection (in aHR): 0.51 (0.44–0.58) and 0.67 (0.61–0.74), respectively. Moreover, for all vaccine types, but to different extents, a post-infection dose given to individuals who were fully vaccinated before first infection was protective.
Conclusions:
In previously vaccinated and infected individuals, an additional vaccine dose provided protection against Omicron variant reinfection. These observations will inform future policy decisions on COVID-19 vaccination in China and other countries.
Funding:
This study was funded the Key Discipline Program of Pudong New Area Health System (PWZxk2022-25), the Development and Application of Intelligent Epidemic Surveillance and AI Analysis System (21002411400), the Shanghai Public Health System Construction (GWVI-11.2-XD08), the Shanghai Health Commission Key Disciplines (GWVI-11.1-02), the Shanghai Health Commission Clinical Research Program (20214Y0020), the Shanghai Natural Science Foundation (22ZR1414600), and the Shanghai Young Health Talents Program (2022YQ076).
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- Epidemiology and Global Health
Background:
The role of circulating metabolites on child development is understudied. We investigated associations between children’s serum metabolome and early childhood development (ECD).
Methods:
Untargeted metabolomics was performed on serum samples of 5004 children aged 6–59 months, a subset of participants from the Brazilian National Survey on Child Nutrition (ENANI-2019). ECD was assessed using the Survey of Well-being of Young Children’s milestones questionnaire. The graded response model was used to estimate developmental age. Developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Partial least square regression selected metabolites with a variable importance projection ≥1. The interaction between significant metabolites and the child’s age was tested.
Results:
Twenty-eight top-ranked metabolites were included in linear regression models adjusted for the child’s nutritional status, diet quality, and infant age. Cresol sulfate (β=–0.07; adjusted-p <0.001), hippuric acid (β=–0.06; adjusted-p <0.001), phenylacetylglutamine (β=–0.06; adjusted-p <0.001), and trimethylamine-N-oxide (β=–0.05; adjusted-p=0.002) showed inverse associations with DQ. We observed opposite directions in the association of DQ for creatinine (for children aged –1 SD: β=–0.05; pP=0.01;+1 SD: β=0.05; p=0.02) and methylhistidine (–1 SD: β = - 0.04; p=0.04;+1 SD: β=0.04; p=0.03).
Conclusions:
Serum biomarkers, including dietary and microbial-derived metabolites involved in the gut-brain axis, may potentially be used to track children at risk for developmental delays.
Funding:
Supported by the Brazilian Ministry of Health and the Brazilian National Research Council.
