Racial/Ethnic Disparities in Access to Telehealth Visits: Results From the COVID-19 and Cancer Outcomes Study

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Non-Hispanic Black and Hispanic outpatients with cancer were less likely to participate in telehealth visits and more likely to become infected with COVID-19 compared with non-Hispanic White patients, according to results of a prospective cohort study conducted at 2 cancer centers. These findings were presented at the European Society of Medical Oncology (ESMO) Virtual Congress 2020.

Although the momentous impact of widespread COVID-19 infections on the care of cancer patients has been widely recognized, less is known how the pandemic has affected different subgroups of patients with cancer characterized according to race/ethnicity.

This study, called the COVID-19 and Cancer Outcomes Study, included a large cohort of outpatients at 2 cancer centers, Mount Sinai Hospital in New York, NY and Dana-Farber Cancer Institute, Boston, MA, with an index/baseline visit between March 2 and March 6, 2020. Data regarding patient demographic characteristics, COVID-19 status, the numbers of in-person and telehealth visits, and the timing of treatment were collected at baseline, retrospectively for the preceding 3 months by chart review, and prospectively for the following 3 months.

Odds ratios (OR) adjusted for potential confounding factors that evaluated these endpoints in Black and Hispanic patients in comparison with White patients were obtained through multivariate analyses.

Of the 2365 patients included in the study, the median patient age was approximately 64 years, and the racial/ethnic distribution was 56.9% non-Hispanic White, 12.6% non-Hispanic Black, 12.6% Hispanic, 7.1% other, and 10.8% unknown. Tumor status was defined as locally/locally advanced/stable in 34.5% and metastatic/active in 43% of patients, respectively, and approximately two-thirds of patients were receiving systemic anticancer therapy at baseline.  

According to the presentation abstract, at a median follow-up of 84 days, the frequencies of COVID-19 were 3.5%, 9%, and 13.8% in non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively.

Compared with non-Hispanic White patients, the adjusted ORs for COVID-19 were 1.86 (1.10–3.11) and 3.19 (2.00–5.10) for non-Hispanic Black and Hispanic patients, respectively.

While the frequencies of in-person visits decreased by approximately 50% in all patient subgroups during the prospective follow-up period compared with the previous 3 months, increases in the rates of telehealth visits during this time were reported for 37.8%, 23.8%, and 21.9% of non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively.

Compared with non-Hispanic White patients, the adjusted ORs associated with telehealth visits were 0.69 (0.50–0.94) for non-Hispanic Black patients and 0.71 (0.51 – 0.98) for Hispanic patients.

In addition, compared with non-Hispanic White patients, the adjusted OR for Hispanic patients with respect to treatment delays was 1.53 (95% CI, 1.03-2.26).

Antonio Passaro, MD, PhD, of the European Institute of Oncology, Milan, Italy, the discussant of the study, said: “… considering that all the evaluated patients were US citizens — therefore from a high-income country — these data are dramatic and require a structured debate.”

Deborah Doroshow, MD, PhD, Tisch Cancer Institute, Icahn School of Medicine of Mount Sinai, added: “Minority patients have experienced a disproportionate burden of cancer care disruptions due to the COVID-19 pandemic, and interventions aimed to narrow these disparities in care delivery are warranted.”

Disclosures: Some of the presenters reported financial relationships with the pharmaceutical industry and health/medical companies. For a full list of disclosures, please refer to the original abstract.

Read more of Cancer Therapy Advisor‘s coverage of the ESMO Virtual Congress 2020 by visiting the conference page.

Reference

Doroshow D, Schmidt AL, Bakouny Z, et al. Disparities in cancer during the COVID-19 pandemic: COVID-19 and Cancer Outcomes Study (CCOS). Presented at: European Society of Medical Oncology (ESMO) Virtual Congress 2020; September 19-21, 2020. Abstract LBA74.