Racial and ethnic disparities have been widely reported during the COVID-19 pandemic, as minority groups have been disproportionately impacted by the virus. Social inequities have resulted in increased risks of COVID-19 exposure, illness, hospitalization and death for these groups.

For cancer patients, health care disparities among racial and ethnic minority groups are recognized as a main reason for poorer outcomes within these populations. It was previously unknown how these health disparities also impacted cancer treatment and care delivery for minority populations diagnosed with COVID-19.

In a study recently presented at the American Association for Cancer Research Annual Meeting, Dr. Jessica Islam, assistant member of Moffitt Cancer Center’s Cancer Epidemiology Program, and her team set out to evaluate if racial and ethnics inequities existed within treatment delivery for cancer patients who were diagnosed with COVID-19 during their treatment trajectory.

To answer this question, data was obtained from the American Society of Clinical Oncology Survey on COVID-19 and Oncology Registry, including data from cancer patients diagnosed with COVID-19 during their care. Data included patient demographics, COVID-19 diagnosis and treatment, cancer clinical characteristics and cancer treatment details, including any modifications to treatment plans.

"Our study suggests it is likely that the disparate impact of the pandemic on marginalized communities with cancer will be exacerbated given their elevated risk of both COVID-19 and existing disparities in access to cancer care prior to the pandemic."

- Dr. Jessica Islam, Cancer Epidemiology Program

Cancer treatment delay or discontinuation was defined as any treatment postponed more than two weeks from the original scheduled date. While evaluating reasons for delays reported by clinics, and demographic and clinical characteristics, Islam’s team then compared disparities in treatment delays by race and ethnicity as a proxy for the potential impact of racism.

“Based on our analyses, we demonstrated that racial and ethnic minority cancer patients with COVID-19 are more likely to experience delays or discontinuations in cancer care compared to their non-Hispanic white counterparts during the pandemic period, even after accounting for important factors such as COVID-19 severity, cancer stage and cancer type,” said Islam.

Upon diagnosis of COVID-19, 49% of cancer patients with prescribed treatments experienced delays and treatment discontinuation. Among these patients, non-Hispanic Black (64%) and Hispanic (57%) patients were more likely to experience treatment delays than non-Hispanic whites (46%). When the participating clinics were asked why cancer treatment was delayed or discontinued, over 90% reported that it was due to the patient’s COVID-19 disease. However, since the modeling takes that into consideration, that doesn’t appear to truly be the case.

“Given that racial and ethnic minorities are more likely to develop COVID-19, cancer patients from minoritized communities are at particular risk for comorbid COVID-19 and severe outcomes,” says Islam. “Our study suggests it is likely that the disparate impact of the pandemic on marginalized communities with cancer will be exacerbated given their elevated risk of both COVID-19 and existing disparities in access to cancer care prior to the pandemic. This is an important finding within the context of the quality of care delivered to minority communities during the pandemic.”

Moving forward, Islam says that the lasting impacts of these treatment delays will need to be addressed in the coming years as this will contribute to the widening disparity in cancer outcomes between racial and ethnic groups. She says it is important to dig further into why Black and Latino cancer patients were more likely to experience treatment delays even after considering their COVID-19 disease severity.

The next step in her research is to evaluate potential reasons for cancer treatment delay or discontinuation from the patient’s perspective. Multiple patient-level factors may have played a role including trust in the health care system or patient-provider communication. Islam and her team will explore these factors to inform the development of interventions that may improve cancer care during future public health emergencies.