Inequities in timely cancer treatment after testing positive for COVID-19: Findings from the ASCO Survey on COVID-19 in Oncology (ASCO) Registry

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.