In the United States, black or African-American patients with cancer and COVID-19 were more likely than non-Hispanic white patients to have delays or disruptions in cancer treatment during the pandemic, according to results of the American Society of Clinical Oncology (ASCO) Survey on COVID-19 in Oncology Registry that were presented during the 2022 ASCO meeting.
“We found that among non-Hispanic black or African-American patients, there was a 3-times greater likelihood of treatment delay or discontinuation compared to non-Hispanic whites. This could lead to poorer outcomes and mortality related to cancer among blacks,” said lead investigator Jessica Islam, PhD, MPH, Assistant Professor, Moffitt Cancer Center, Tampa, FL.
“There could be multiple reasons for this. Patients may fear coming to the clinic during peaks of SARS-CoV-2 [COVID-19] infection. Patient–provider communication may have broken down during this period,” Dr Islam added.
The data were collected between March 2020 and July 2021 and included 804 patients with breast cancer who were diagnosed with COVID-19 during their treatment at 46 practices across the United States. Breast cancer treatment delay or discontinuation was defined as any treatment postponed for more than 2 weeks from the originally scheduled date.
The patients included in the survey were predominantly aged ≥50 years (75%) and urban residents (83%).
The racial makeup of the sample was 13.3% non-Hispanic blacks, 11.7% Hispanics, 4.9% American Indians, 4.6% Asians, and 65% non-Hispanic whites.
At the time of diagnosis of COVID-19 in 736 (91%) of the patients, 78% were scheduled to receive drug therapy, 8% radiation therapy, and 6% surgery. Of these 736 patients, 39% had treatment delay or discontinuation. Severe treatment delays occurred for 1% of the total study population versus 13% of the non-Hispanic blacks, which was the highest rate among the various ethnic groups. When broken down by urban versus rural patients, non-Hispanic black patients with cancer continued to have significant delays and discontinuations of their cancer treatment in both residential areas.
Across all treatment modalities, the most common reason cited by clinicians (approximately 90%) for treatment delay or discontinuation was COVID-19.
Multivariate analyses were adjusted for age, number of comorbidities, cancer stage, Eastern Cooperative Oncology Group (ECOG) performance score, pandemic periods based on case peaks, and the severity of COVID-19, including death, hospitalization, intensive care unit stay, and mechanical ventilation.
Rural versus Urban Setting
In a second analysis, Dr Islam and colleagues looked in greater detail at rural versus urban settings and the effect on treatment delay and discontinuation in all patients with cancer who were diagnosed with COVID-19 during the pandemic and were included in the ASCO Survey on COVID-19 in Oncology Registry. This analysis included 499 patients who lived in a rural setting and 2689 patients who lived in an urban setting.
“In a multivariate analysis, rural cancer patients were 28% less likely to experience a treatment delay or discontinuation compared to urban cancer patients during the pandemic,” Dr Islam said. “A potential explanation is that rural cancer patients are more likely to have access to care, while urban cancer patients are more likely to rely on urban transportation.”
Compared with urban patients with cancer and COVID-19, rural patients were significantly more likely to be non-Hispanic white (81% vs 63%, respectively), reside in the Midwest (40% vs 27%, respectively), and have an ECOG score of 5 or 6 (36% vs 28%, respectively; P <.001 for all).
Most rural patients received cancer care in urban areas (65%), but were more likely than urban patients to receive care at a rural clinic (35% vs 1%, respectively; P <.001). Rural patients were less likely than urban patients to receive care through telemedicine (18% vs 26%, respectively; P <.001). Those living in rural areas were also less likely than urban patients to have severe COVID-19 infection (31% vs 37%, respectively; P = .009) and to have COVID-19–related complications (17% vs 24%, respectively; P <.001).
At the time of their COVID-19 diagnosis, the rural patients were scheduled to receive drug therapy (72%), radiation therapy (8%), surgery (4%), or transplant (1%).