Black Patients with Cancer and COVID-19 More Likely to Have Treatment Disruptions Than White Patients

August 2022, Vol 13, No 4 Online Only

According to data from the American Society of Clinical Oncology (ASCO) Survey on COVID-19 in Oncology Registry, black or African-American patients with cancer and COVID-19 were more likely than non-Hispanic white patients to experience delays or disruptions in cancer treatment during the pandemic. These findings were presented during a poster session at the 2022 ASCO Annual Meeting.

“We found that among non-Hispanic black and African-American patients, there was a 3-times greater likelihood of treatment delay or discontinuation compared with non-Hispanic whites. This could lead to poorer outcomes and mortality related to cancer among blacks,” said lead investigator Jessica Y. Islam, PhD, MPH, Assistant Professor of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL. Dr Islam explained that there could be multiple reasons for these disparities. “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,” she noted.

Analysis of ASCO Survey on COVID-19 in Oncology Registry

Data were obtained from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-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 more than 2 weeks from the originally scheduled date.

Most patients included in the survey were aged ≥50 years (75%) and lived in urban settings (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. Of these 736 patients, 39% experienced treatment delay or discontinuation. 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 severity of COVID-19, including death, hospitalization, intensive care unit stay, and mechanical ventilation.

Severe treatment delays were reported in 1% of the study population versus 13% of the non-Hispanic blacks, which was the highest rate among the various racial groups. When broken down by urban versus rural patients, non-Hispanic black patients with cancer continued to experience significant delays and discontinuations in their treatment in both residential settings.

Impact of Rural versus Urban Settings

In a second analysis, Dr Islam and colleagues examined the effect of rural and urban settings on treatment delay and discontinuation in all patients with cancer diagnosed with COVID-19 during the pandemic who were included in the ASCO Survey on COVID-19 in Oncology Registry. This analysis included 499 patients living in a rural setting and 2689 patients living in an urban setting. At the time of COVID-19 diagnosis, rural patients were scheduled to receive drug-based therapy (72%), radiation therapy (8%), surgery (4%), or transplant (1%).

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 performance 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 via telemedicine (18% vs 26%, respectively; P <.001). Patients living in rural areas were also less likely than those living in urban areas 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).

“In a multivariate analysis, rural patients with cancer were 28% less likely to experience a treatment delay or discontinuation compared with urban patients with cancer during the pandemic,” Dr Islam said. “A potential explanation [for this finding] is that rural patients with cancer are more likely to have access to care, while urban patients with cancer are more likely to rely on urban transportation.”

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