Disparities observed in receipt of cancer treatment during COVID-19 pandemic
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Certain racial and ethnic minority patients with cancer experienced worse treatment delays and adverse social and economic effects due to the COVID-19 pandemic than white patients, according to study results published in JAMA Network Open.
Rationale and methods
The COVID-19 pandemic highlighted the association of systemic racism and inequities in the structural, economic and socioenvironmental system; however, the full effect on disparities in cancer care, especially according to race and ethnicity, is not well known, according to study background.
“Cancer care delivery disparities have persisted for decades prior to the pandemic and racial and ethnic minorities with cancer have experienced greater rates of cancer care delays, lower rates of receipt of evidence-based cancer care and, hence, worse cancer survival,” Manali I. Patel, MD, MPH, MS, assistant professor of medicine in the division of oncology at Stanford University School of Medicine, told Healio. “At the beginning of the pandemic, as care was delayed for many with cancer, I was keenly concerned that the care delays would be worse among particular populations, namely racial and ethnic minorities with cancer, for whom cancer care delivery was already markedly delayed and worse. [We therefore] sought to identify whether the delays were greater for people from particular racial and ethnic backgrounds and to examine this lens from the perspectives of the patients themselves, given that they would be able to accurately report their delays across the U.S., rather than awaiting retrospective analysis from cancer registries or electronic health records.”
Delays in cancer treatment according to race and ethnicity served as the primary outcome. Duration of delay, adverse social and economic effects, concerns and trusted sources of COVID-19 information served as secondary outcomes.
Key findings
Results showed Black respondents (OR = 6.1; 95% CI, 3.5-10.7) and Hispanic or what the study referred to as Latinx patients (OR = 2.7; 95% CI, 1.4-5.1) had higher odds of involuntary treatment delays compared with white respondents. Black respondents also had greater odds of treatment delays longer than 4 weeks (OR = 3.1; 95% CI, 1.1-8.8).
Researchers additionally found that compared with white respondents, Black respondents (OR = 4.3; 95% CI, 2.6-7) and Hispanic or Latinx respondents (OR = 6.1; 95% CI, 3.5-10.5) experienced greater odds of food insecurity, as well as concerns about food security (Black respondents, OR = 2; 95% CI, 1.3-3; Hispanic or Latinx respondents, OR = 2.9; 95% CI, 1.8-4.6).
Moreover, Black (OR = 3.5; 95% CI, 1.7-7) and Hispanic or Latinx respondents (OR = 4.2; 95% CI, 1.9-9.2) appeared more likely to report greater concerns about financial stability and the ability to afford cancer treatment (Black respondents, OR = 4.2; 95% CI, 2.2-8.2; Hispanic or Latinx respondents, OR = 2.8; 95% CI, 1.4-5.3).
Significant variations in trusted sources of COVID-19 information also varied by race and ethnicity.
“Trust is an essential component associated with an individual’s understanding of information and willingness to act, and it varies by race and ethnicity,” the researchers wrote. “In this study... Black and [Hispanic or] Latinx adults had less trust in the federal government, and Black adults had less trust in physicians for COVID-19 information. Increased vaccination rates among Black adults through efforts led predominantly by community and church or faith-based organizations support the importance of partnering with sources of trust to improve health outcomes for individual groups.”
Implications
These findings highlight the fact that the pandemic has worsened cancer care delivery and timely access to care for Black and Latinx adults, according to Patel. They additionally show the disproportionate social and economic impacts of the COVID-19 pandemic that are likely to impact cancer mortality among these populations, she said.
“We must routinely and continually examine our practices and policies in our clinics, as well as our data, to ensure that we are not disproportionately worsening care disparities for particular populations,” Patel told Healio. “We must also develop solutions in partnership with communities to overcome these disparities. We have launched several initiatives in partnership with organizations to ensure that individuals, who are disproportionately at risk, are able to access and receive timely cancer care. We also must strongly advocate for policies that prevent ongoing harm to these communities and one another, including mask mandates, vaccinations and testing.”
For more information:
Manali I. Patel, MD, MPH, MS, can be reached at manalip@stanford.edu.
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