Black and Hispanic Patients Were More Likely to Delay Cancer Pharmacotherapy During the COVID-19 Pandemic

During the COVID-19 pandemic, ethnicity and area-level social determents of health were associated with delays in or discontinuation of treatment for cancer in the United States.¹

Early in the COVID-19 pandemic, before widespread availability of vaccines, healthcare delivery was widely disrupted to accommodate the influx of patients sick with COVID-19² and to reduce exposure to SARS-CoV-2.^2,3 For people with cancer, frequent contact with the health care system for disease management and treatment increased risk for exposure to SARS-CoV-2, especially for the subset of patients who had comorbid chronic conditions.⁴ These factors led to widespread interruptions in diagnostic screening and treatment for cancer both to mitigate exposure risk and due to resource reallocation.^2,3

Delaying cancer treatment is associated with poorer survival.¹ In general, Black and Hispanic communities have poorer cancer outcomes⁵ due at least in part to delaying treatment and seeking treatment in safety-net settings.⁶

As certain populations had pre-existing inequities in cancer outcomes, Adana AM Llanos, PhD, MPH, an associate professor at Columbia University Mailman School of Public Health, hypothesized that individuals who belonged to racial and ethnic minority groups or who lived in socioeconomically disadvantaged areas would be disproportionately affected by the cancer treatment delays associated with the COVID-19 pandemic.

In a paper published in JAMA Network Open, Dr Llanos and colleagues tested their hypothesis in a registry-based cohort study using data from the American Society for Clinical Oncology Survey on COVID-19 in Oncology (ASCO) Registry. Patients with cancer (N=4768) and a confirmed positive SARS-CoV-2 test residing in the US between April 2020 and September 2022 were evaluated for trends in cancer treatment delays and discontinuation on the basis of sociodemographic characteristics.

The study cohort comprised 3173 White, 630 Hispanic, 568 Black, and 196 Asian American or Pacific Islander individuals.

Overall, 69.3% of patients were receiving or scheduled to receive pharmacotherapy, 7.2% were receiving or scheduled to receive radiotherapy, 4.4% were scheduled to undergo surgery within the next six weeks, 2.7% had undergone surgery in the past six weeks, 2.9% were enrolled in a therapeutic clinical trial for their cancer, and 0.8% were enrolled in hospice.

Stratified by ethnicity, fewer patients who were Hispanic (59.5%), Asian American or Pacific Islander (64.8%), or Black (68.1%) were receiving or scheduled to receive pharmacotherapy compared with White patients (72.1%; P <.001) and fewer of the minority groups received their pharmacotherapy within 14 days of their planned schedule (30.5%-40.3%) compared with White patients (43.7%; P <.001).

“We were not surprised by these findings because they are in line with persistent inequities in cancer. There’s evidence that racial and ethnic minority groups are consistently more likely to have delayed cancer treatment or to receive suboptimal cancer treatment and care across the cancer continuum,” Dr Llanos told Hematology Advisor.