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Interview

Cancer and COVID-19: Identifying Routine Disruptions, Racial Disparities in Care


November 12, 2020

By Julie Gould 

deb DoroshowRecent study findings, which were posted online in Cancer Cell, show that patients with cancer receiving care during the COVID-19 pandemic experienced significant disruptions to routine cancer care—particularly among patients from minority racial and ethnic backgrounds. 

“Oncologists and health care systems have adapted the delivery of cancer care to mitigate the increased risk of morbidity and mortality from COVID-19 among oncology patients,” wrote the study authors. “However, the ways in which the pandemic has incited changes in multidisciplinary cancer care remain poorly defined with minimal prospective data.” 

To better understand the study, including the significant disruptions to cancer care during the pandemic period relative to the prior 3 months,  we spoke with Deborah B Doroshow, MD, PhD, assistant professor of medicine, Tisch Cancer Institute, Icahn School of Medicine. 

What existing data led you and your co-investigators to conduct this research? 

As the COVID-19 pandemic began, medical oncologists and our clinical colleagues involved in cancer care had to make very rapid adjustments to the delivery of care in order to minimize patient contact with the health care setting, which we hoped would decrease exposure to the novel coronavirus. Some of the changes made throughout the country included delaying surgeries, delaying visits, and adopting telehealth to minimize in-person visits. While other groups were examining the effect of COVID-19 on patients with active cancer or a history of cancer, we wanted to ask a slightly different question – how was the pandemic affecting the delivery of cancer care? While clinicians around the world were sharing their experiences with cancer care delivery, we wanted to collect information in a rigorous, prospective manner. 

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising? 

The COVID-19 and Cancer Outcomes Study is a multicenter prospective cohort study designed to define the impact of the pandemic on cancer care delivery and outcomes. The cohort comprised 2365 patients seen in the outpatient hematology and oncology clinics at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York City and the Dana-Farber Cancer Institute in Boston from March 2 to March 6, 2020. We collected data on these patients at baseline, retrospectively from the preceding 3 months, and prospectively at 3-month follow up. Our primary endpoint was the impact of COVID-19 on clinical care as measured by number of outpatient visits and number of telehealth visits, and secondary endpoints included outcomes of patients who developed COVID-19 and pandemic-related delays of planned oncologic care. We found that 51% of patients had decreased in-person visits in the pandemic period compared to the baseline period, and that 32% had increased telehealth visits. 5.5% of the patients in our cohort developed COVID-19. Most notably, compared to White patients, Black and Hispanic patients were less likely to have telehealth visits, had no significant change in frequency of in-person visits, and were more likely to develop COVID-19. Moreover, Hispanic patients were more likely than White patients to have pandemic-related delays in dancer care.  

What are the possible real-world applications of these findings in clinical practice?

Our findings suggest that not only were there significant disruptions to cancer care during the pandemic period relative to the prior 3 months, but these disruptions were disproportionately experienced by patients from minority racial and ethnic backgrounds. Moreover, minority patients were more likely to be diagnosed with COVID-19, in line with research suggesting that members of these populations are more vulnerable to COVID-19 in general. This information should give us pause in how we continue to adapt cancer care delivery during the ongoing pandemic, which unfortunately continues to grow. For example, we learned that Black and Hispanic patients were less likely to experience increased telehealth visits. Why the reasons for this are not clear and may include language barriers or inaccessibility to high-speed internet or smartphones, this finding reminds us that we cannot assume that patients will be able to participate in telehealth. Before trying this approach we need to ensure that patients are equipped to participate both technologically and educationally; we may need to implement sessions to explain how telehealth platforms can be utilized before the appointment, for example. It was also troubling to see that Hispanic patients were more likely to experience pandemic-related delays in cancer care. Again, while our study did not identify the reasons for this, we must take special care to ensure that patients who are already more vulnerable to COVID-19 are not lost to follow up and do not experience disproportionate care delays.

Do you and your co-investigators intend to expand upon this research? 

Yes. We were fortunate to work with a large team of collaborators and are still analyzing the data we have collected. Right now, we are seeking to better understand how the pandemic impacted clinical trial enrollment and participation, which are considered a critical component of high-quality cancer care.

About Dr Doroshow

Deborah Doroshow, MD, PhD is an Assistant Professor of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai. She is a medical oncologist specializing in developmental therapeutics for patients with advanced solid tumors and lung cancer.  

Reference:

Schmidt AL, Bakouny Z, Bhalla S, et al. Cancer Care Disparities during the COVID-19 Pandemic: COVID-19 and Cancer Outcomes Study [published online ahead of print, 2020 Nov 3]. Cancer Cell. 2020;S1535-6108(20)30554-7. doi:10.1016/j.ccell.2020.10.023

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