Older patients received cancer treatment less frequently during the pandemic, as did patients covered by Medicaid.
Non-Hispanic Black and Hispanic patients were more likely to have a delay or discontinuation of cancer treatment and pharmacology after COVID-19 infection compared to non-Hispanic White patients, according to a recent study.
The COVID-19 pandemic highlighted many cancer patient inequalities that increase risk of infection, including living in metropolitan areas, living in lower-income apartment complexes, the overrepresentation of racial and ethnic minority groups in essential jobs, their increased use and risks associated with public transportation, and the increased likelihood of living in a multigenerational house, putting seniors at risk.
Area-level social determinants of health (SDOH) such as geography, proportion of residents without health insurance, lower education, and lower median household income, can all lead to discrimination and lack of health care access. These determinants also corresponded with delayed treatment of at least 14 days, according to the study.
“Treatment patterns during the COVID-19 pandemic support higher rates of noninitiation, discontinuation, and nonadherence to adjuvant endocrine therapy among patients with cancer from racial and ethnic minority groups,” said study authors in a recent article published in JAMA Network Open.
Historically, Black and Hispanic populations have worse cancer outcomes, and these communities were also disproportionately affected by the pandemic. Delays in cancer treatment are associated with high cancer-related morbidity and mortality, and the experts noted that survival inequalities could be affected for years because of COVID-19.
The researchers hypothesized that racial and ethnic minority groups in low-income areas would have more delayed or discontinued treatment compared to White patients in higher socioeconomic status (SES) areas following COVID-19 infection. They conducted a study to evaluate patient-level factors, area-level SDOH, and delayed or discontinued treatment following SARS-CoV-2 infection.
The team identified 4768 racially diverse patients aged 70 years and older to participate in the retrospective, registry-based cohort study. The study population included 630 Hispanic, 196 non-Hispanic Asian American or Pacific Islander, 568 non-Hispanic Black, and 3173 non-Hispanic White patients who were already enrolled in the American Society for Clinical Oncology (ASCO) COVID-19 Registry.
Black patients appeared to have been most affected, having a 37% greater likelihood of delayed or discontinued treatment and pharmacology. The findings also show that Hispanic patients had a 17% increased likelihood of delay or discontinuation compared to non-Hispanic White people.
The results further suggest that geography and area-level SDOH were associated with delayed or discontinued treatment.
This is “consistent with the understanding that residents of socioeconomically disadvantaged areas are more likely to experience various forms of health inequalities, independent of individual-level factors associated with those outcomes,” the study authors said in the paper.
The study includes limitations. First, it excludes deceased patients. The registry-based style may also contribute to selection bias, failing to account for patients not lab-tested for COVID-19. Additionally, passive data collection could increase the likelihood of confounding variables, especially as they relate to area-level SDOH.
“It is our hope that these data contribute to the development and implementation of multilevel interventions targeting microlevel and macrolevel determinants to reduce the likelihood of delayed oncology care among vulnerable patient populations during public health emergencies,” the study authors said in the article.
Llanos A, Ashrafi A, Ghosh N, et al. Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection. Accessed on January 16, 2023. JAMA Netw Open. 2023;6(1):e2251165. doi:10.1001/jamanetworkopen.2022.51165