Previous reports of patients with Coronavirus disease 2019 (COVID-19) showed higher severity of disease in cancer patients, including the intubation rate [1]. These series focused on those with symptoms from COVID-19 requiring hospitalization, with lung cancer being the most frequent malignancy [1, 2]. We report characteristics and outcomes of COVID-19 + patients with breast cancer (BC) at an academic center in New York City.

Methods

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.

Results

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/m2 (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 +.

Table 1 Baseline demographics, treatments, and outcomes in COVID-19 + patients with a history of breast cancer (n = 27)
Full size table

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%).

Fig. 1
figure 1

a Percentage of COVID-19-related symptoms with which patients presented who had a history of stage I–IV breast cancer (n = 27). b Percentage of these patients who presented with 0, 1, 2, 3, or at least 4 COVID-19-related symptoms

Full size image

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-year-old male with coronary artery disease, hypertension, and former smoker who received taxane-based chemotherapy for stage II BC seven days before symptoms.

Discussion

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.