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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2023-10
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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
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 ClinicalTrials.gov, NCT04354701.Type
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Nagaraj, Gayathri, Shaveta Vinayak, Ali Raza Khaki, Tianyi Sun, Nicole M Kuderer, David M Aboulafia, Jared D Acoba, Joy Awosika, et al. (2023). 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. p. e82618. 10.7554/elife.82618 Retrieved from https://hdl.handle.net/10161/31555.
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Scholars@Duke
Gary Herbert Lyman
Dr. Gary Lyman is Adjunct Professor of Medicine in the Division of Medical Oncology, Department of Internal Medicine at Duke University School of Medicine . He is a nationally and internationally recognized authority on comparative effectiveness and health services and outcomes research. Lyman research has been funded by the National Cancer Institute, the National Heart Lung and Blood Institute, the American Society of Clinical Oncology along with industry grants related to supportive cancer care. Dr Lyman has published some 700 research articles in in the professional medical literature.
Personal Statement
I have been extremely privileged to work with some of the worlds best biostatisticians and clinical trialists over the years including a postdoctoral fellowship with Professor Marvin Zelen, chair of Biostatistics at the Harvard School of Public Health and as a Visiting Professor with Professor Stuart Pocock at the the London School of Hygiene and Tropical Medicine and Professor Doug Altman at the Oxford Centre for Health Statistics as well as many others now in the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center. It has been very humbling and a true honor to work with and learn from such professionals. These wonderful colleagues have made it possible for me to be listed among the top 1% of most highly cited investigators by Web of Science for the past 7 years with nearly 97,000 professional citations. Thank you all. https://en.wikipedia.org/wiki/Gary_Herbert_Lyman
Dr Lyman’s research interests include:
Personalized Medicine and Cancer Supportive Care: In addition to the conduct of randomized controlled trials of new cancer diagnostic, prognostic, treatment and supportive care approaches, Dr Lyman’s research interests include the personalized management of early-stage breast cancer and supportive care of patients receiving cancer chemotherapy, most notably those at risk for febrile neutropenia and venous thromboembolism. Based on clinical trial results, Dr Lyman is actively involved in the development and validation of clinical risk models for patient selection and targeted intervention and preventive strategies. Dr Lyman is co-PI on an NCI on comparative effectiveness of cancer pharmacogenomics grant to discover and validate new genomic tools for guiding more personalized cancer treatments and on an NHLBI trial of thromboprophylaxis in high risk ambulatory patients receiving cancer chemotherapy.
Evidence synthesis, clinical practice guidelines and health policy: Dr Lyman conducts systematic reviews and meta-analyses of major clinical issues in support of clinical practice guidelines. Dr Lyman chairs several guidelines for the American Society of Clinical Oncology including those on antiemetics, venous thromboembolism, sentinel node biopsy in patients with breast cancer and cutaneous melanoma and on weight based dosing of chemotherapy. Dr Lyman also conducts analyses of large population studies of clinical outcomes associated with of current cancer patient management in a real world setting with a particular focus on cancer management in the elderly patient with cancer. Dr Lyman leads several decision simulation studies for improved clinical decision making and cost-effectiveness analysis of new and novel therapies based on results of clinical trials, systematic reviews and population studies. He serves as an advisor on new oncologic agents to the US FDA. Dr Lyman also serves as Editor-in-Chief of Cancer Investigation and on the editorial boards of several prestigious research journals.
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