Racial and Ethnic Disparities in Cancer Care During the COVID-19 Pandemic

Abstract

<div class="section"> <a class="named-anchor" id="ab-zoi220621-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e435">Question</h5> <p id="d549814e437">Did racial and ethnic minority adults with cancer in the United States experience more cancer care delays and adverse social and economic effects than White adults during the COVID-19 pandemic? </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e440">Findings</h5> <p id="d549814e442">In this survey study of 1240 US adults with cancer, Black and Latinx adults reported experiencing higher rates of delayed cancer care and more adverse social and economic effects than White adults. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e445">Meaning</h5> <p id="d549814e447">This study suggests that the COVID-19 pandemic is associated with disparities in the receipt of timely cancer care among Black and Latinx adults. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e451">Importance</h5> <p id="d549814e453">The full effect of the COVID-19 pandemic on cancer care disparities, particularly by race and ethnicity, remains unknown. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e456">Objectives</h5> <p id="d549814e458">To assess whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays, adverse social and economic effects, and concerns during the COVID-19 pandemic and to evaluate trusted sources of COVID-19 information by race and ethnicity. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e461">Design, Setting, and Participants</h5> <p id="d549814e463">This national survey study of US adults with cancer compared treatment delays, adverse social and economic effects, concerns, and trusted sources of COVID-19 information by race and ethnicity from September 1, 2020, to January 12, 2021. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e466">Exposures</h5> <p id="d549814e468">The COVID-19 pandemic.</p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e471">Main Outcomes and Measures</h5> <p id="d549814e473">The primary outcome was delay in cancer treatment by race and ethnicity. Secondary outcomes were duration of delay, adverse social and economic effects, concerns, and trusted sources of COVID-19 information. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e476">Results</h5> <p id="d549814e478">Of 1639 invited respondents, 1240 participated (75.7% response rate) from 50 US states, the District of Columbia, and 5 US territories (744 female respondents [60.0%]; median age, 60 years [range, 24-92 years]; 266 African American or Black [hereafter referred to as <i>Black</i>] respondents [21.5%]; 186 Asian respondents [15.0%]; 232 Hispanic or Latinx [hereafter referred to as <i>Latinx</i>] respondents [18.7%]; 29 American Indian or Alaska Native, Native Hawaiian, or multiple races [hereafter referred to as <i>other</i>] respondents [2.3%]; and 527 White respondents [42.5%]). Compared with White respondents, Black respondents (odds ratio [OR], 6.13 [95% CI, 3.50-10.74]) and Latinx respondents (OR, 2.77 [95% CI, 1.49-5.14]) had greater odds of involuntary treatment delays, and Black respondents had greater odds of treatment delays greater than 4 weeks (OR, 3.13 [95% CI, 1.11-8.81]). Compared with White respondents, Black respondents (OR, 4.32 [95% CI, 2.65-7.04]) and Latinx respondents (OR, 6.13 [95% CI, 3.57-10.53]) had greater odds of food insecurity and concerns regarding food security (Black respondents: OR, 2.02 [95% CI, 1.34-3.04]; Latinx respondents: OR, 2.94 [95% CI, [1.86-4.66]), financial stability (Black respondents: OR, 3.56 [95% CI, 1.79-7.08]; Latinx respondents: OR, 4.29 [95% CI, 1.98-9.29]), and affordability of cancer treatment (Black respondents: OR, 4.27 [95% CI, 2.20-8.28]; Latinx respondents: OR, 2.81 [95% CI, 1.48-5.36]). Trusted sources of COVID-19 information varied significantly by race and ethnicity. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi220621-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d549814e490">Conclusions and Relevance</h5> <p id="d549814e492">In this survey of US adults with cancer, the COVID-19 pandemic was associated with treatment delay disparities and adverse social and economic effects among Black and Latinx adults. Partnering with trusted sources may be an opportunity to overcome such disparities. </p> </div><p class="first" id="d549814e495">This survey study assesses whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays and adverse social and economic effects during the COVID-19 pandemic. </p>