Treatment Delays for Patients with Cancer During Pandemic Linked to Social Factors, Vaccination Status

Individual patient factors, social determinants of health (SDOH), and COVID-19 severity and diagnosis date were associated with exacerbated health disparities in cancer treatment delays during the pandemic, according to a study published in JAMA Network Open.

As a result of the COVID-19 pandemic, cancer care has been frequently delayed or disrupted, resulting in amended care guidelines that helped clinicians prioritize patients with higher-risk disease to avoid treatment delays and suggested alternatives. However, much of the research on this topic focuses on patients with cancer who did not contract COVID-19 themselves.

To assess the associations of patient factors, SDOH, severity of COVID-19, and timing of COVID-19 diagnosis with the risk of treatment delay among patients with cancer, researchers conducted a prospective cohort study using the American Society of Clinical Oncology COVID-19 Oncology Data Registry.

The study was conducted from March 2020 through July 2021 at 60 academic and community medical practices in the United States. Participants included patients with any cancer diagnosis who were scheduled for treatment and contracted COVID-19. Researchers analyzed treatment delay, defined as more than 14 days between the date originally planned for treatment and the date of initiation of therapy, or discontinuation of therapy.

A total of 3028 patients were included in the registry, 2103 of whom had scheduled anticancer drug treatment.

Researchers found that 962 of these 2103 patients (46%) experienced anticancer drug delays or discontinuation. Delays were higher among Black patients compared to White patients (odds ratio [OR], 1.87; 95% CI, 1.40-2.51), and for Hispanic or Latino patients compared with non-Hispanic or Latino patients (OR, 1.91; 95% CI, 1.34-2.72).

These findings are in line with previous data showing persistent disparities in COVID-19–related outcomes in subgroups of disadvantaged and minority patients and populations.

Patients with 2 or more comorbidities experienced higher delays compared with patients with 0 to 1 comorbidities (OR, 1.23; 95% CI, 1.00-1.53), as did patients with metastatic disease rather than locoregional disease (OR, 1.63; 95% CI, 1.29-2.05).

Patients who experienced COVID-19 complications also had higher delays than those who did not (OR, 1.52; 95% CI, 1.24-1.86).

A lower likelihood of drug therapy delay was associated with living in an area with a higher proportion of residents reporting Hispanic or Latino ethnicity (OR, 0.76; 95% CI, 0.60-0.95) and contracting COVID-19 later in the pandemic (eg, January to March 2021: OR, 0.38; 95% CI, 0.26-0.53).

The authors suggest that that changes in COVID-19 management, and correspondingly, patient outcomes, emerged as clinicians developed an increasing understanding of the disease and made more nuanced accommodations to improve access to care as the pandemic progressed. COVID-19 vaccination was also associated with lower likelihood of anticancer drug delay, indicating that the vaccine can improve outcomes in this high-risk population.

A total of 95 of 202 patients (47%) experienced delay or discontinuation of radiation treatment, with having 2 or more comorbidities associated with delay (OR, 2.69; 95% CI, 1.20-6.20). Higher local-area median household income was associated with lower likelihood of radiation treatment delay (OR, 0.41; 95% CI, 0.17-0.94).

Of 125 patients who scheduled surgical treatment, 89 (71%) experienced delay. For surgical treatment, delays were higher among patients in the South compared with those in the Midwest (OR, 9.66; 95% CI, 2.14-52.3). The researchers noted an interesting finding that patients with 2 or more comorbidities experienced lower likelihoods of surgical treatment delay compared to patients with 0 to 1 (OR, 0.26; 95% CI, 0.07-0.88).

While an increased propensity for treatment delay was not observed among patients with hematologic malignant neoplasms compared with those with solid tumors overall, a greater association of hematologic malignant neoplasm with treatment delay was observed compared with the breast cancer group.

Overall, multiple patient factors, including race and ethnicity, underlying primary malignant neoplasms, multimorbidity, geographic location, receipt of COVID-19 vaccine, severity of COVID-19, and timing of COVID-19 diagnosis, were found to be associated with delays in cancer treatment.

“Quantification of the impact of COVID-19 on practice management can provide insight to health system leaders and public health authorities about the extent of disruptions in care, and differential impacts on vulnerable and/or disadvantaged populations,” the authors wrote.

They hope that their study can help inform proposals for well-targeted strategies to improve planning, preparation, patient support, and resource allocation during the ongoing COVID-19 pandemic and future national health emergencies.

The study had some limitations. The study only enrolled patients who had test results positive for SARS-CoV-2, meaning that researchers had no information on control patients with cancer but without COVID-19 who were treated in the same practices and who may or may not have experienced delay.

Additionally, cause of delay could not be determined, making it difficult to determine whether delays were related to symptoms of COVID-19, isolation requirements, or structural factors.

The authors suggest that future analyses should be performed as the American Society of Clinical Oncology COVID-19 Oncology Data Registry continues to recruit patients and increase in size.

Reference

Mullangi S, Aviki E M, Chen Y, et al. Factors associated with cancer treatment delay among patients diagnosed with COVID-19. JAMA Network Open. 2022;5(7):e2224296. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794732?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072822