key: cord-0997189-4lrh8p3e
authors: Kalinsky, Kevin; Accordino, Melissa K.; Hosi, Kristina; Hawley, Jessica E.; Trivedi, Meghna S.; Crew, Katherine D.; Hershman, Dawn L.
title: Characteristics and outcomes of patients with breast cancer diagnosed with SARS-Cov-2 infection at an academic center in New York City
date: 2020-05-14
journal: Breast Cancer Res Treat
DOI: 10.1007/s10549-020-05667-6
sha: 637fe5080f52546f83866d64871599f5b1bfc85b
doc_id: 997189
cord_uid: 4lrh8p3e

nan

We collected demographic, treatment, and outcome data from established patients with stage I-IV BC at Columbia University Irving Medical Center (CUIMC) and COVID-19 + from 3/10/20 to 4/29/20 (data cut off). COVID-19 + was determined by reverse transcription-polymerase chain reaction (RT-PCR) by nasal swab and/or high clinical or radiographic suspicion. Initially, all outpatients with symptoms were referred to the emergency department (ED) for testing; however, outpatient testing, including at an ambulatory referral-based CUIMC fever clinic, was rapidly expanded with cobas® SARS-CoV-2 testing (Roche). This study was CUIMC Institutional Review Board approved.

Of the 4515 COVID-19 + total patients at CUIMC, 27 (0.6%) were established patients with a history of BC (Table 1) . Twenty-six (96%) were female; 15 (56%) White, 6 (22%) Black, and 12 (44%) identified as Hispanic. The median age was 56 years (range: 32-87), median body mass index was 28.5 kg/m 2 (range: 21-47), and 7 (26%) were current/former smokers. Co-morbidities included 15 (56%) with hypertension, 6 (22%) diabetes, and 6 (22%) pulmonary disease. The majority had stage I-III BC and 5 (19%) metastatic disease. In the 6 months prior to COVID-19 + , 16 (59%) received chemotherapy, 12 (44%) hormone therapy, 6 (22%) HER2-directed therapy, 1 (4%) checkpoint inhibitor, 6 (22%) breast surgery, and 2 (7%) radiation therapy. Prior to COVID-19 + , the last received therapy was chemotherapy for 14 patients [52%, median: 12 days (range 7-749)], 10 (37%) hormone therapy [median: 1 day (range 1-81)], and 3 (11%) HER2-directed antibodies without chemotherapy [median: 21 days (range 20-34)]. Treatment disruptions occurred in 20 patients (74%) due to COVID-19 +.

Most common symptoms were cough (70%), fever (52%), shortness of breath (52%), fatigue (30%), diarrhea (22%), and myalgia (19%), with 30% having ≥ 4 symptoms (Fig. 1) . Twenty-two patients (81%) had COVID-19 + confirmation by RT-PCR, 4 (15%) presumed COVID-19 + per clinical symptoms, and 1 (4%) based on imaging and symptoms. Eight (30%) were initially tested in the ED, of whom 3 were not admitted. The majority were tested in the outpatient setting: ambulatory oncology clinic (6 patients; 22%) or CUIMC fever clinic (8 patients: 30%).

Of the 7 patients requiring hospitalization (26%), 3 were non-Hispanic Black, 3 Hispanic White, and 1 non-Hispanic White. Two received recent chemotherapy without targeted agents for early stage BC and 5 single-agent hormone therapy (1 for metastatic disease). Five admitted patient had at least 1 co-morbid disease, and 3 were former smokers. Five admitted patients required supplemental oxygen, and none needed intensive care-level support, including intubation or dialysis. All were discharged from the hospital. With a median follow-up from COVID-19 + diagnosis of 26 days (range 1-38), all patients were alive, except for an 87-yearold male with coronary artery disease, hypertension, and former smoker who received taxane-based chemotherapy for stage II BC seven days before symptoms.

In our racially/ethnically diverse population of 27 COVID-19 + patients with BC, the majority (74%) did not require hospitalization, and one male with multiple co-morbidities died. This is of interest, as COVID-19 + males have reported worse outcomes than females [3] . While treatment disruptions occurred in most patients (74%), it is unknown whether this represents a deviation from other patients who develop infections on therapy. While larger series are needed to understand the impact of COVID-19 in patients with BC, these initial data are reassuring that a substantial number recover from their infection.

Funding No funding to report. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent Informed consent was obtained from all individual participants included in the study.

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