The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease coronavirus 2019 (COVID-19), has ravaged the United States since the first case was documented in Washington State in January 2020. By early March, the first case of COVID-19 was confirmed in New York. From the very first case to present day, it has become increasingly clear that densely populated cities bear the brunt of this disease. In New York City as of July 7, 2020, approximately 214 000 cases and 18 000 deaths have been documented. While COVID-19 has had a worldwide impact, suspicions about its disproportionate effects on minority populations have now been confirmed with the release of data stratified by race and ethnicity. Within New York, we are witnessing 2 distinct trajectories and risk groups defined along the lines of race and socioeconomic status. As of July 7, 2020, the age-adjusted death rate for Hispanic and Black patients is twice that of White patients. 1 Additionally, the Bronx, Queens, and Brooklyn each have twice the number of cases per 100 000 individuals as Manhattan and 3 to 4 times the number of cases as Staten Island. The reasons for these disparities have been discussed at length and include rates of preexisting comorbidities, a majority of the population employed in essential bluecollar jobs, living conditions, health literacy, and access to health care. 2 The impact of these changes on already wellestablished cancer care disparities is unknown but potentially devastating. At this time, oncologists have had to make difficult decisions weighing the benefits of treatment against the risks of COVID-19 infection and the increased risk of death among patients with cancer. Surgeries have been postponed, and chemotherapy and radiotherapy regimens have been delayed or altered to expedite treatment and minimize risk of exposure to coronavirus. It remains unclear the extent to which active or prior cancer diagnosis influences one's risk of COVID-19 infection. In a study of 1099 Chinese patients, cancer patients comprised 1% of COVID-19 cases. However, in initial reports from New York City, patients with cancer represent 6% of COVID-19 cases and 8% to 9% of those deemed critically ill or requiring mechanical ventilation. Moreover, patients with non-small cell lung cancer comprised more than half of COVID-19 cancer cases, suggesting differing susceptibilities based on the primary disease. 3 Nationwide, the breast cancer mortality rate is 40% higher for Black patients compared with White patients. In New York City, this inequity has worsened over time, increasing from 19% to 27% between 2005 to 2014. Similarly, the cervical cancer mortality rate is 23% higher for Hispanic women and 71% higher for Black women as well as for those residing in poorer neighbor-VIEWPOINT

Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.

IntroductionThe number and lifespan of individuals living with HIV have increased significantly with the scale-up of antiretroviral therapy. Furthermore, the incidence of breast cancer in women with HIV is growing, especially in sub-Saharan Africa (SSA). However, the association between HIV infection and breast cancer is not well understood.MethodsA literature search was performed to identify articles published in journals pertaining to breast cancer and HIV, with an emphasis on SSA. Selected US-based studies were also identified for comparison.ResultsAmong the 56 studies reviewed, the largest study examined 314 patients with breast cancer and HIV in the United States. There is no consensus on whether HIV infection acts as a pro-oncogenic or antioncogenic factor in breast cancer, and it may have no relation to breast cancer. A higher incidence of breast cancer is reported in high-income countries than in SSA, although breast cancer in SSA presents at a younger age and at a more advanced stage. Some studies show that patients with breast cancer and HIV experience worse chemotherapy toxicity than do patients without HIV. Data on treatment outcomes are limited. The largest study showed worse treatment outcomes in patients with HIV, compared with their counterparts without HIV.ConclusionHIV infection has not been associated with different clinical presentation of breast cancer. However, some evidence suggests that concurrent diagnosis of HIV with breast cancer is associated with increased therapy-related toxicity and worse outcomes. Systematic prospective studies are needed to establish whether there is a specific association between breast cancer and HIV.

There are considerable challenges to meeting the demands of the impending cancer crisis in Africa. These include a rising incidence of cancer and cancer-related deaths, equipment and maintenance costs, and deficits in human resources and training. Addressing these issues would be crucial to tackling the increasing burden of cancer on the continent. Innovations in technology and collaborative efforts within the global oncology community have created promising solutions for establishing quality cancer care in Africa and eradicating the massive disparities that currently exist. A multifaceted approach that establishes access to quality radiation oncology services is needed to curtail this alarming trend. In this article, we describe the current status of radiotherapy services in Africa, barriers and opportunities to improve this integral component of comprehensive cancer care.

Background New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. Methods A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. Results Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. Conclusions More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.

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BACKGROUND New York City (NYC) emerged as an epicenter of the COVID‐19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID‐19 on cancer treatment, anxiety, and financial distress among low‐income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS Medicaid‐insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self‐report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19‐86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID‐19 prevalence area, a delay in medical care resulted in a 4‐fold increased rate of anxiety (P = .023, 95% CI, 1.278‐14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.

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