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

Patel, Manali I.; Ferguson, Jacqueline; Castro, Eida; Pereira-Estremera, Cristina D; Armaiz-Peña, Guillermo N.; Durón, Ysabel; Hlubocky, Fay J.; Infantado, Analynn; Nuqui, Bles; Julian, Donna; Nortey, Nii; Steck, Alexandra; Bondy, Melissa L.; Maingi, Shail

doi:10.1001/jamanetworkopen.2022.22009

Cited by 30 publications

(46 citation statements)

References 47 publications

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“…For patients with Medicaid, the observed to expected proportions in 2020 for digestive system, female genital, head and neck, lymphoma, or soft-tissue malignant neoplasms among others were not significantly different from previous years. Whether these findings reflect disparities in cancer prevention, screening, treatment, or outcomes for marginalized groups during the first pandemic year will require further study …”

Section: Discussionmentioning

confidence: 99%

“…Demographic characteristics of cancer cases in 2020 in the NCDB reflected in some ways previous reports of exposure and access to general medical care during the outset of the pandemic. 4,5,22 The observed to expected proportions decreased for patients diagnosed with cancer in 2020 who were of Asian or Pacific Islander, Hispanic, and non-Hispanic Black race and ethnicity, had lower education and income levels, or had Medicaid or no insurance. However, the observed to expected proportion of patients with private insurance, at highest income levels, and of younger age also decreased.…”

Section: Ncdb Case Characteristics In 2020mentioning

confidence: 99%

“…3 As ambulatory and hospital-based care resumed, albeit differently from previous years, economic consequences of COVID-19 revealed inequitable impacts on communities. 4,5 These forces may have further altered the incidence of cancer diagnosis and treatment during the height of the pandemic. [5][6][7][8] The impact of the COVID-19 pandemic on the number and distribution of cancer diagnoses captured in the NCDB has not been determined.…”

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confidence: 99%

“…4,5 These forces may have further altered the incidence of cancer diagnosis and treatment during the height of the pandemic. [5][6][7][8] The impact of the COVID-19 pandemic on the number and distribution of cancer diagnoses captured in the NCDB has not been determined. While monitoring real-time data submissions, 9 the CoC noted variances in new cancer diagnoses in the first several months of 2020.…”

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confidence: 99%

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Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

et al. 2023

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ImportanceEach year, the National Cancer Database (NCDB) collects and analyzes data used in reports to support research, quality measures, and Commission on Cancer program accreditation. Because data models used to generate these reports have been historically stable, year-to-year variances have been attributed to changes within the cancer program rather than data modeling. Cancer submissions in 2020 were anticipated to be significantly different from prior years because of the COVID-19 pandemic. This study involved a validation analysis of the variances in observed to expected 2020 NCDB cancer data in comparison with 2019 and 2018.ObservationsThe NCDB captured a total of 1 223 221 overall cancer cases in 2020, a decrease of 14.4% (Δ = −206 099) compared with 2019. The early months of the COVID-19 pandemic (March-May 2020) coincided with a nadir of cancer cases in April 2020 that did not recover to overall prepandemic levels through the remainder of 2020. In the early months of the COVID-19 pandemic, the proportion of early-stage disease decreased sharply overall, while the proportion of late-stage disease increased. However, differences in observed to expected stage distribution in 2020 varied by primary disease site. Statistically significant differences in the overall observed to expected proportions of race and ethnicity, sex, insurance type, geographic location, education, and income were identified, but consistent patterns were not evident.Conclusions and RelevanceHistorically stable NCDB data models used for research, administrative, and quality improvement purposes were disrupted during the first year of the COVID-19 pandemic. NCDB data users will need to carefully interpret disease- and program-specific findings for years to come to account for pandemic year aberrations when running models that include 2020.

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Section: Discussionmentioning

confidence: 99%

Section: Ncdb Case Characteristics In 2020mentioning

confidence: 99%

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Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

et al. 2023

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“… 22 , 26 , 28 , 29 , 30 , 31 A national United States (US) survey demonstrated that Black and Latinx adults with cancer self‐reported higher rates of cancer treatment delays and affordability of their cancer treatments. 32 Black patients have been disproportionately affected by the COVID‐19 pandemic with higher rates of morbidity and mortality when compared to other racial groups. 33 , 34 , 35 , 36 As Black patients also have proportionally higher rates of late‐stage cancers compared with other races, we hypothesized that the COVID‐19 pandemic would further exacerbate racial disparities in cancer stage at presentation.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on breast, colorectal, lung, and prostate cancer stage at diagnosis according to race

et al. 2022

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Purpose To determine if the COVID‐19 pandemic has further exacerbated racial disparities in late‐stage presentation of breast, colorectal, lung, and prostate cancers. Methods We conducted a registry‐based retrospective study of patients with newly reported diagnoses of breast, colorectal, lung, and prostate cancers between March 2019–June 2019 (pre‐COVID‐19) and March 2020–June 2020 (early‐COVID‐19). We compared the volume of new diagnoses and stage at presentation according to race between both periods. Results During the study period, a total of 3528 patients had newly diagnosed cancer; 3304 of which had known disease stages and were included in the formal analyses. 467 (14.1%) were Blacks, and 2743 were (83%) Whites. 1216 (36.8%) had breast, 415 (12.6%) had colorectal, 827 (25%) had lung, and 846 (25.6%) had prostate cancers, respectively. The pre‐COVID‐19 period included 2120 (64.2%), and the early‐COVID‐19 period included 1184 (35.8%), representing a proportional 44.2% decline in the volume of new cases of breast, colorectal, lung, and prostate cancers, p < 0.0001. Pre‐COVID‐19, 16.8% were diagnosed with metastatic disease, versus 20.4% early‐COVID‐19, representing a proportional increase of 21.4% in the numbers of new cases with metastatic disease, p = 0.01. There was a non‐significant proportional decline of 1.9% in Black patients diagnosed with non‐metastatic breast, colorectal, lung, and prostate cancers early‐COVID‐19 ( p = 0.71) and a non‐significant proportional increase of 7% in Black patients diagnosed with metastatic disease ( p = 0.71). Difference‐in‐difference analyses showed no statistically significant differences in metastatic presentation comparing Black to White patients. Conclusion While we identified substantial reductions in the volume of new cancer diagnoses and increases in metastatic presentations due to the COVID‐19 pandemic, the impact was similar for White and Black patients.

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Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses

et al. 2023

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ImportancePrior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable.ObjectiveTo examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending.Design, Setting, and ParticipantsThis cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023.ExposureCancer history.Main Outcomes and MeasuresThe main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending.ResultsOf 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending.Conclusions and RelevanceIn this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.

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

Cited by 30 publications

References 47 publications

Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

Impact of the COVID‐19 pandemic on breast, colorectal, lung, and prostate cancer stage at diagnosis according to race

Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses

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