Gayathri Nagaraj
Shaveta Vinayak
Ali Raza Khaki
Tianyi Sun
Nicole M. Kuderer
David M. Aboulafia
Jared D. Acoba
Joy Awosika
Ziad Bakouny
Nicole B. Balmaceda
Ting Bao
Babar Bashir, Thomas Jefferson UniversityFollow
Stephanie Berg
Mehmet A. Bilen
Poorva Bindal
Sibel Blau
Brianne E. Bodin
Hala T. Borno
Cecilia Castellano
Horyun Choi
John Deeken
Aakash Desai
Natasha Edwin
Lawrence E. Feldman
Daniel B. Flora
Christopher R. Friese
Matthew D. Galsky
Cyndi J. Gonzalez
Petros Grivas
Shilpa Gupta
Marcy Haynam
Hannah Heilman
Dawn L. Hershman
Clara Hwang
Chinmay Jani
Sachin R. Jhawar
Monika Joshi
Virginia Kaklamani
Elizabeth J. Klein
Natalie Knox
Vadim S. Koshkin
Amit A. Kulkarni
Daniel H. Kwon
Chris Labaki
Philip E. Lammers
Kate I. Lathrop
Mark A. Lewis
Xuanyi Li
Gilbert de Lima Lopes
Gary H. Lyman
Della F. Makower
Abdul-Hai Mansoor
Merry-Jennifer Markham
Sandeep H. Mashru
Rana R. McKay
Ian Messing
Vasil Mico, Thomas Jefferson UniversityFollow
Rajani Nadkarni
Swathi Namburi
Ryan H. Nguyen
Taylor Kristian Nonato
Tracey Lynn O'Connor
Orestis A. Panagiotou
Kyu Park
Jaymin M. Patel
Kanishka GopikaBimal Patel
Jeffrey Peppercorn
Hyma Polimera
Matthew Puc
Yuan James Rao
Pedram Razavi
Sonya A. Reid
Jonathan W. Riess
Donna R. Rivera
Mark Robson
Suzanne J. Rose
Atlantis D. Russ
Lidia Schapira
Pankil K. Shah
M Kelly Shanahan
Lauren C. Shapiro
Melissa Smits
Daniel G. Stover
Mitrianna Streckfuss
Lisa Tachiki
Michael A. Thompson
Sara M. Tolaney
Lisa B. Weissmann
Grace Wilson
Michael T. Wotman
Elizabeth M. Wulff-Burchfield
Sanjay Mishra
Benjamin French
Jeremy L. Warner
Maryam B. Lustberg
Melissa K. Accordino
Dimpy P. Shah

Document Type


Publication Date



This article is the author’s final published version in eLife, Volume 12, October 2023, Article number e82618.

The published version is available at


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.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Public Domain Dedication 1.0 License.

PubMed ID




Included in

Oncology Commons