ABSTRACT
Introduction: There is a disproportionately greater burden of COVID-19 among non-Hispanic Black (NHB) and Hispanic individuals, who also shoulder an inordinate burden of poor cancer outcomes. Understanding patient- and area-level factors contributing to these inequities at the intersection of COVID-19 and cancer is critical. As such, the objective of this study was to evaluate inequities in receipt of timely cancer treatment following a confirmed positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-the virus that causes COVID-19. Method(s): This retrospective cohort study is comprised of 2,686 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic cancer patients from the American Society for Clinical Oncology COVID-19 Registry (ASCO Registry), for whom relatively complete data were available at entry into the registry (at the date of confirmed positive SARS-CoV-2 test) up to the end of the follow-up period (~6-9 months post confirmed positive SARS-CoV-2 test). Data were collected from April 2020 to November 2021. Relative risk (RR) estimates (generated using the generalized linear model procedure with a Poisson distribution, log link, and robust error variances) were used to examine multivariable-adjusted associations between patient-level sociodemographic and clinical factors and area-level social determinants of health (SDOH), separately, with timely (on schedule or within 14 days of schedule) and delayed (>=14-day delay) receipt of cancer treatment. Kaplan-Meier curves were plotted to investigate the time (in days) to restart cancer treatment post-COVID-19 infection. Result(s): After correction for multiple comparisons, for drug-based therapy, NHB race (RR, 0.69 [95% CI, 0.55-0.87];P=.002) and male sex (RR, 0.82 [95% CI, 0.71-0.95];P=.009) were associated with 31% and 18% reductions in timely treatment receipt. NHB race (RR, 1.41 [95% CI, 1.17-1.71];P<.001) was also associated with a 41% increased risk of >=14-day delays in treatment receipt. NHB patients further experienced longer delays, on average, in restarting drug-based therapy relative to NHW and Hispanic patients (mean days: 54.7 vs. 36.6 and 36.7, P=.001). Hispanic ethnicity was marginally associated with a lower likelihood of timely drug-based therapy receipt (RR, 0.79 [95% CI, 0.61-1.02];P=.075) and a greater risk of delayed receipt of drug-based therapy (RR, 1.31 [95% CI, 1.04-1.67];P=.024). Residents of areas with higher proportions of NHWs (>=77.4% vs. <77.4%) had a 31% higher likelihood of timely drug-based therapy receipt (RR, 1.31 [95% CI, 1.18-1.47];P<.001) and 21% significantly lower risk of delayed drug-based therapy (RR, 0.79 [95% CI, 0.69- 0.90];P=.001). Conclusion(s): NHB cancer patients, males, and residents of areas that are more racially and ethnically diverse experienced delayed drug-based cancer treatment following COVID19 infection. These delays will likely exacerbate persistent cancer survival inequities in the United States.
ABSTRACT
Background: Screening for HCV is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma, and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an EHR alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Method(s): Data was ed from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody screening dates. Mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened for a limited period from 1/1/2020 to 10/31/2020 and centered on the EHR alert implementation. Result(s): Absolute number of screens increased by 103% after the implementation of the EHR alert. When comparing the five-month period before and after the EHR alert, the odds of being screened at an outpatient visit increased by 62% from 17 to 27 screens per 1,000 outpatient visits. Also during this time period, patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, [CI95: 1.05, 1.15]), females more likely than males (1.26, [1.20, 1.32]);Black race more than White (1.59, [1.53, 1.64]);while those with Medicare were less likely than private insurance (0.62, [0.62, 0.65]). Over the entire 58-month period, the HCV Ab positivity rate decreased from 4.2% to 1.5%. Conclusion(s): Implementation of a universal HCV screening EHR alert was followed by a large increase in absolute screens and screening rates in the outpatient setting, despite the concurrent onset of the COVID-19 pandemic. These findings support that such an alert could play a crucial role in identification and subsequent elimination of HCV. Females, Black race and Medicaid patients were screened at higher rates, suggesting possible bias toward certain groups. Targeted testing in addition to universal screening remains a need despite much higher screening rates -expectedly, the proportion screened decreased, however the absolute number of HCV positive individuals decreased over time (data not shown). Our findings suggest that an EHR alert for universal screening could play a crucial role as the first step in identification and then elimination of HCV.