Older and Black Breast Cancer Survivors at Higher Risk for Negative Respiratory Outcomes Following COVID-19 Infection

Background: Negative respiratory outcomes have been reported in people diagnosed with COVID-19. Breast cancer, the most common cancer diagnosed in women globally, is an important cancer to investigate regarding COVID-19 outcomes. We hypothesized that women with breast cancer and infected with COVID-19 would demonstrate a greater risk for negative respiratory outcomes than people without breast cancer. Objective: We sought to examine associations between breast cancer diagnosis, COVID-19 infection, and negative respiratory outcomes using an Oracle Real World dataset. Method: Horn and Gassaway’s Practice-Based Evidence Framework structured this retrospective cohort study. Regression analysis identified associations among negative respiratory outcomes and breast cancer and COVID-19 diagnosis. Associations between preexisting comorbidities and COVID-19 infection complications in the dataset were also examined. Results: Breast cancer and COVID-19 diagnoses significantly predict increased odds of developing a negative respiratory outcome (OR = 1.11, CI 1.01-1.23, P = .03). Additional predictors of negative respiratory outcomes include advanced age (OR = 4.88, CI 4.21-5.65, P < .001); Black race (OR = 1.19, CI 1.11-1.28, P < .001); history of emergency department visits (OR = 1.33, CI 1.27-1.40, P < .001); and history of respiratory illness (OR = 2.60, CI 2.41-2.81, P < .001). Race/ethnicity (Asian or Hispanic), age 20 to 34, and pre-index ischemic stroke or atrial fibrillation were not significantly associated with increased odds of negative respiratory outcomes. Conclusion: Black and older women with breast cancer are at increased risk of developing negative respiratory outcomes following a COVID-19 infection compared to younger and White women with breast cancer. Implications for clinical practice are discussed.