COVID-19 in breast cancer patients: a subanalysis of the OnCovid registry

Abstract

Background: Cancer patients are at higher risk of COVID-19 complications and mortality than the rest of the population. Breast cancer patients seem to have better prognosis when infected by SARS-CoV-2 than other cancer patients. Methods: We report a subanalysis of the OnCovid study providing more detailed information in the breast cancer population. Results: We included 495 breast cancer patients with a SARS-CoV-2 infection. Mean age was 62.6 years; 31.5% presented more than one comorbidity. The most frequent breast cancer subtype was luminal-like ( n = 245, 49.5%) and 177 (35.8%) had metastatic disease. A total of 332 (67.1%) patients were receiving active treatment, with radical intent in 232 (47.6%) of them. Hospitalization rate was 58.2% and all-cause mortality rate was 20.3%. One hundred twenty-nine (26.1%) patients developed one COVID-19 complication, being acute respiratory failure the most common ( n = 74, 15.0%). In the multivariable analysis, age older than 70 years, presence of COVID-19 complications, and metastatic disease were factors correlated with worse outcomes, while ongoing anticancer therapy at time of COVID-19 diagnosis appeared to be a protective factor. No particular oncological treatment was related to higher risk of complications. In the context of SARS-CoV-2 infection, 73 (18.3%) patients had some kind of modification on their oncologic treatment. At the first oncological reassessment (median time: 46.9 days ± 36.7), 255 (51.6%) patients reported to be fully recovered from the infection. There were 39 patients (7.9%) with long-term SARS-CoV-2-related complications. Conclusion: In the context of COVID-19, our data confirm that breast cancer patients appear to have lower complications and mortality rate than expected in other cancer populations. Most breast cancer patients can be safely treated for their neoplasm during SARS-CoV-2 pandemic. Oncological treatment has no impact on the risk of SARS-CoV-2 complications, and, especially in the curative setting, the treatment should be modified as little as possible.

Does breast Cancer have a lower risk of mortality from Severe Acute Respiratory Syndrome compared to other types of Cancer? Evidence from Brazil, a heterogeneous population

“…An explanation for the lower mortality rate in BC patients would be the existence of some level of hormonal protection, especially estrogen. Therefore, in the study conducted by Garrigós et al, 2021, that suggested this association, the authors observed that mortality rates from COVID-19 were slightly lower in BC patients (11%) than in those women diagnosed with other types of genitourinary cancer (14%). Based on these results, we have included here a complementary analysis comparing the mortality rate between BC and GC patients younger (18 to 49 years) and those aged 50 years and over.…”

Outcomes of the same‐day discharge following mastectomy before, during and after COVID‐19 pandemic

“…The hospitals had no choice but either delay cancer surgeries or transition to the ambulatory surgery with telemedicine follow‐up 11 . This change was driven by the common goal to preserve resource for COVID‐19 positive patients without compromising long‐term outcomes for breast cancer patients 10,12,13 …”

“…11 This change was driven by the common goal to preserve resource for COVID-19 positive patients without compromising long-term outcomes for breast cancer patients. 10,12,13 One of the practice-changing recommendations that emerged during the pandemic was an increased use of Enhanced Recovery After Surgery (ERAS) pathways.…”

Pandemic Phase-Adjusted Analysis of COVID-19 Outcomes Reveals Reduced Intrinsic Vulnerability and Substantial Vaccine Protection From Severe Acute Respiratory Syndrome Coronavirus 2 in Patients With Breast Cancer

“…Similarly, the putative detrimental effect of recent exposure to active anticancer therapy before the infection appears to be attenuated in this patient population. 12…”

“…Similarly, the putative detrimental effect of recent exposure to active anticancer therapy before the infection appears to be attenuated in this patient population. 12 Outcomes from COVID-19 in patients with cancer have also considerably evolved over time. Enhanced health care system capacity and improved management of COVID-19, 13 widespread immunization campaigns, 14 shifting changes in community transmission, and the emergence of new SARS-CoV-2 variants 15 have dramatically changed the clinical impact of SARS-CoV-2 infection since declaration of the pandemic in March 2020.…”