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COVID-19 has disrupted cancer care, particularly among minority groups

ESMO 2020
Reuters Health - 22/09/2020 - The COVID-19 pandemic has led to significant disruptions in routine cancer care, especially among racial and ethnic minority groups, according to the COVID-19 and Cancer Outcomes Study (CCOS).

"Unfortunately, the pandemic has further exacerbated existing health inequities in its impact upon the delivery of cancer care," Dr. Deborah Doroshow, with the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, in New York City, told Reuters Heath by phone.

Minority patients with cancer have suffered a "disproportionate burden" of care disruptions due to the COVID-19 pandemic, "and interventions aimed to narrow these disparities in care delivery are needed," she added.

The findings were presented September 20 at the European Society of Medical Oncology (ESMO) Virtual Congress 2020.

The CCOS cohort includes 2,365 cancer outpatients (median age 64, 46% women) from Mount Sinai Hospital in New York and Dana-Farber Cancer Institute in Boston. The cohort was 57% non-Hispanic White, 13% non-Hispanic Black, 13% Hispanic, 7% other, and 11% unknown.

Data were collected at the index/baseline visit (between March 2 to 6, 2020), retrospectively from the preceding three months and prospectively at the three-month follow-up visit.

Overall, a little more than half of all patients (52%) had a decrease in numbers of in-person visits in the pandemic period compared to the baseline period and 32% had increased telehealth visits.

However, an increase in telehealth visits was less likely among non-Hispanic Black (24%) and Hispanic (22%) cancer patients than White patients (38%). Hispanic patients were also more likely to have treatment delays than White patients.

There may be a number of issues that decrease access to telehealth in minority groups, Dr. Doroshow said, "including limited access to broadband internet and to technology like smartphones that will allow patients to use telehealth."

"Language barriers can be a huge problem and health literacy can also limit a patient's ability to use telehealth or to understand why their appointment is being canceled or changed from an in-person appointment to a telehealth appointment. For all of these reasons, these patients are more vulnerable to losing contact with the healthcare system, making it hard to maintain quality cancer care," she said.

Non-Hispanic Black and Hispanic cancer patients in the cohort were also more likely to have COVID-19. At a median follow-up of 84 days, the frequencies of COVID-19 were 3.5% in non-Hispanic White patients compared with 9% in non-Hispanic Black and 14% in Hispanic patients.

Compared with non-Hispanic White patients, the adjusted odds ratio for COVID-19 was 1.86 for non-Hispanic Black patients and 3.19 for Hispanic patients.

"We are continuing to follow these patients and will be reporting a six-month follow-up soon," Dr. Doroshow told Reuters Health. "And we also continue to look at the data we've collected so far, which really is an immense database and we hope to have a lot more information to share soon about how the pandemic has impacted cancer care delivery."

By Megan Brooks

SOURCE: https://bit.ly/3iRRnou European Society of Medical Oncology Virtual Congress 2020, presented September 20, 2020.

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