UChicago Interdisciplinary Cancer Health Disparities SPORE

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOTCA-20-042. The ongoing pandemic of the coronavirus disease 2019 (COVID-19) is a public health and economic emergency that has disrupted the lives of breast cancer patients. Unfortunately, it has hit the United States heavily with more than 1.7 million people having been infected and more than 100,000 lives lost to date. While old age and having comorbidities are risk factors for dying from COVID-19, there is also a racial disparity in COVID-19 severity, with black and Latino patients in urban centers dying disproportionately from COVID-19. Breast cancer is the most common malignancy in women, with over 3.8 million women living in the United States with a history of invasive breast cancer. African Americans with breast cancer have an elevated risk of all-cause mortality and breast cancer-specific mortality. During the COVID-19 pandemic, it is important to understand the impact of SARS-CoV-2 infection and COVID-19 on breast cancer disease progression, care delivery, and survivorship including quality of life during and after the COVID-19 outbreak. In response to the needs of patients participating in our P20 funded UChicago Interdisciplinary Health Disparities SPORE and to address these knowledge gaps, we propose to engage with the Community by conducting an online survey, reviewing electronic health records, and searching the National Death Index to determine status of 3,059 breast cancer patients in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. The project has three specific aims: First, we will evaluate the extent of treatment interruption because of COVID-19 outbreak, and understand the utilization and satisfaction with Telehealth. Second, we will conduct a holistic evaluation of COVID-19 and mitigation efforts on loneliness, anxiety, stress, economic impact, and lack of resources among breast cancer patients. Third, we will estimate the coronavirus infection rate, severity and case-fatality rate of COVID-19, and identify factors associated with severity and case-fatality rate of COVID-19. For each aim, we will examine racial differences to understand whether COVID-19 has worsened previously identified mortality gap in the Cohort. The Supplementary Project will greatly enhance our SPORE P20 program by supporting additional interviews and follow-up of the cancer cohort members, and will generate necessary data regarding the impact of COVID-19 epidemic and lockdown on translational research to close the mortality gap in our proposed full SPORE application. These data are critical for guiding both community level interventions and health systems adaptation to support high-risk patients in the era of COVID-19.