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Factors contributing to treatment delays among Medicaid-insured patients with gynecologic malignancies during COVID-19 in New York City
Gynecologic Oncology ; 162:S66-S66, 2021.
Article in English | Academic Search Complete | ID: covidwho-1366720
ABSTRACT
When New York City (NYC) emerged as a COVID-19 epicenter, hospitals and clinicians were forced to quickly change practice models of health care delivery. We sought to determine the impact of COVID-19 on treatment delays that occurred during the peak of the pandemic among low-income gynecologic oncology patients in NYC. Medicaid-insured patients receiving gynecologic oncology care at two affiliated centers between March 15 and April 15, 2020 were identified for telephone interview. Eligible patients included those with precancerous or cancerous gynecologic diseases or hereditary breast and ovarian cancer (HBOC) syndromes. Demographics, clinical characteristics, and reasons for treatment delays were identified through self-report and confirmed with chart review at the time of interview and at 6-month follow up. Outcomes were classified as delays in the following surgery, adjuvant treatment (chemotherapy/radiation), and surveillance visits. Of the 158 eligible patients identified, 100 completed the interview. A total of 47 patients experienced an average treatment delay of 85.3 days (range 7-210) surveillance visit (n=33), surgery (n=10), chemotherapy (n=3), radiation (n=1). Within this group, the median age was 58 years (range 19-86). Self-identified race included African-American (23.5%), Hispanic (31.9%), non-Hispanic White (17%), Asian (9.1%), Other (8.5%). The majority of patients (80.9%) had an annual income < $40,000. Clinically relevant surveillance delays occurred in 3 patients. A delayed diagnosis of vulvar cancer due to missed biopsy (follow up at 49 days) and 2 patients with delayed diagnosis of recurrent ovarian/primary peritoneal cancer;one died from disease and the other is undergoing chemotherapy. Surgical delays were identified in 10 patients high grade cervical/vulvar dysplasia (n=3);endometrial intraepithelial neoplasia (EIN) (n=2);endometrial cancer (n=2);risk reducing surgery for HBOC syndromes (n=2);metastatic gastrointestinal adenocarcinoma to the ovary (n=1). Among the patients with endometrial cancer, one procedure delayed by 1 week was able to proceed and one transferred care. No upstaging of cancer diagnosis resulted from delays. Chemotherapy delays occurred in 3 patients with an average delay of 47.7 days. Of these patients, 2 were found to have progression of disease resulting in death (n=1) and decision to pursue hospice (n=1);one had a personal COVID-19 diagnosis. A delay in radiation treatment of 70 days was reported in 2.1% (n=1). A total of 9 patients were lost to follow up. Characteristics of patients lost to follow up include Hispanic/Latino race/ethnicity, essential worker, living with children in a high COVID-positive area (37.5%, n=3) or individuals who experienced a change in employment status (25%;n=2). [Display omitted] COVID-19 resulted in significant treatment delays among Medicaid-insured gynecologic oncology patients. As we continue to minimize clinical encounters, interventions aimed at providing timely oncology care during the COVID-19 pandemic is essential to prevent widening disparities in low-income populations. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Full text: Available Collection: Databases of international organizations Database: Academic Search Complete Language: English Journal: Gynecologic Oncology Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: Academic Search Complete Language: English Journal: Gynecologic Oncology Year: 2021 Document Type: Article