LBA74 - Disparities in cancer during the COVID-19 pandemic: COVID-19 and cancer outcomes study (CCOS)

Background

The COVID-19 pandemic has rapidly altered cancer care. However, the ways in which it has done so and the associated impact at the individual and societal levels remains poorly defined.

Methods

CCOS is a multicenter prospective cohort study designed to define the impact of the pandemic on cancer care delivery and outcomes. The CCOS cohort comprised consecutive outpatients with cancer seen at two US cancer centers from March 2 to March 6, 2020 (index visit). Data was collected at baseline, retrospectively from the preceding 3 months, and prospectively at 3-month follow up. Per patient changes in numbers of visits were compared using Wilcoxon signed rank tests. Correlates of increases in telehealth visits and decreases in in-person visits were evaluated using multivariable logistic regression models. Adjusted Odds ratios [aOR] and 95% confidence intervals (CI) were reported.

Results

Of 2365 included patients, 1219 (51.6%) had a decrease in in-person visit frequency during the pandemic period relative to the preceding 3 months. Conversely, 760 (32.2%) had an increased frequency of telehealth visits (decrease in in-person and increase in telehealth visits; both p<0.01). 128 (5.4%) patients developed COVID-19. Compared to White patients, Black and Hispanic patients were less likely to have telehealth visits, had no significant change in frequency of in-person visits, and were more likely to develop COVID-19 (Table). Table: LBA74

* Adjusted for cancer disease group, cancer center, cancer status, and receipt of systemic therapy (during index week).

Conclusions

Significant disruptions to routine cancer care were observed during the pandemic period relative to the prior 3 months. Racial and ethnic barriers to the adoption of telehealth, and related socioeconomic factors, place these vulnerable populations simultaneously at disproportionate risk for decreased cancer-related visits and COVID infection, thereby exacerbating existing racial and ethnic health disparities.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

D. Doroshow: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: Athenaeum Partners; Honoraria (self), Advisory/Consultancy: Boston Healthcare Associates. A.L. Schmidt: Travel/Accommodation/Expenses: Pfizer; Travel/Accommodation/Expenses: Astellas. Z. Bakouny: Non-remunerated activity/ies: Bristol Myers Squibb; Research grant/Funding (self): Genentech/ImCore. M.M. Awad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb; Advisory/Consultancy, Research grant/Funding (self): Lilly; Advisory/Consultancy, Research grant/Funding (self): AstraZeneca; Advisory/Consultancy, Research grant/Funding (self): Genentech; Advisory/Consultancy: Merck; Advisory/Consultancy: Achilles; Advisory/Consultancy: AbbVie. R. Haddad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb; Advisory/Consultancy, Research grant/Funding (self): Merck; Advisory/Consultancy, Research grant/Funding (self): Pfizer; Advisory/Consultancy, Research grant/Funding (self): Genentech; Advisory/Consultancy, Research grant/Funding (self): AstraZeneca; Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline. M.D. Galsky: Shareholder/Stockholder/Stock options: Rappta Therapeutics; Honoraria (self): BioMotiv; Honoraria (self): Janssen; Honoraria (self): Dendreon; Honoraria (self): Merck; Honoraria (self): GlaxoSmithKline; Honoraria (self): Lilly; Honoraria (self): Astellas Pharma; Honoraria (self): Genentech; Honoraria (self): Bristol-Myers Squibb; Honoraria (self): Novartis; Honoraria (self): Pfizer; Honoraria (self): EMD Serono; Honoraria (self): AstraZeneca; Honoraria (self): Seattle Genetics; Honoraria (self): Incyte; Honoraria (self): Alleron Therapeutics; Honoraria (self): Dracen; Honoraria (self): Inovio Pharmaceuticals; Honoraria (self): NuMab; Honoraria (self): Dragonfly Therapeutics; Honoraria (institution): Janssen Oncology; Honoraria (institution): Dendreon; Honoraria (institution): Novartis; Honoraria (institution): Bristol-Myers Squibb; Honoraria (institution): Merck; Honoraria (institution): AstraZeneca; Honoraria (institution): Genentech/Roche. T.K. Choueiri: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Alexion; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Bayer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): BristolMyersSquibb; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Cerulean; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Eisai; Honoraria (self), Research grant/Funding (self): Foundation Medicine; Honoraria (self), Research grant/Funding (self): Exelixis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Ipsen; Research grant/Funding (self): 16 Tracon; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Genentech; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche; Honoraria (self), Research grant/Funding (self): Roche Products Limited; Honoraria (self), Research grant/Funding (self): Hoffman-LaRoche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline; Advisory/Consultancy, Research grant/Funding (self): Lilly; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Merck; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Peloton; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Prometheus labs; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Corvus; Research grant/Funding (self): Calithera; Research grant/Funding (self): Analysis Group; Honoraria (self), Research grant/Funding (self): Sanofi/Aventis; Research grant/Funding (self): Takeda; Honoraria (self), Advisory/Consultancy: EMD Serono; Honoraria (self), Advisory/Consultancy: UpToDate; Honoraria (self): NCCN; Honoraria (self), Advisory/Consultancy, Dr. Choueiri reports research support from AstraZeneca, Alexion, Bayer, Bristol Myers Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Ipsen, 16 Tracon, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Lilly, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Corvus, Calithera, Analysis Group, Sanofi/Aventis, Takeda; Honoraria: AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, EMD Serono, Prometheus Labs, Corvus, Ipsen, Up-to-Date, NCCN, Analysis Group, NCCN, Michael J. Hennessy (MJH) Associates, Inc (Healthcare Communications Company with several brands such as OnClive, PeerView and PER), Research to Practice, L-path, Kidney Cancer Journal, Clinical Care Options, Platform Q, Navinata Healthcare, Harborside Press, American Society of Me: Analysis Group. All other authors have declared no conflicts of interest.