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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Did racial and ethnic minority adults with cancer in the United States experience more cancer care delays and adverse social and economic effects than White adults during the COVID-19 pandemic?

Findings  In this survey study of 1240 US adults with cancer, Black and Latinx adults reported experiencing higher rates of delayed cancer care and more adverse social and economic effects than White adults.

Meaning  This study suggests that the COVID-19 pandemic is associated with disparities in the receipt of timely cancer care among Black and Latinx adults.


Importance  The full effect of the COVID-19 pandemic on cancer care disparities, particularly by race and ethnicity, remains unknown.

Objectives  To assess whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays, adverse social and economic effects, and concerns during the COVID-19 pandemic and to evaluate trusted sources of COVID-19 information by race and ethnicity.

Design, Setting, and Participants  This national survey study of US adults with cancer compared treatment delays, adverse social and economic effects, concerns, and trusted sources of COVID-19 information by race and ethnicity from September 1, 2020, to January 12, 2021.

Exposures  The COVID-19 pandemic.

Main Outcomes and Measures  The primary outcome was delay in cancer treatment by race and ethnicity. Secondary outcomes were duration of delay, adverse social and economic effects, concerns, and trusted sources of COVID-19 information.

Results  Of 1639 invited respondents, 1240 participated (75.7% response rate) from 50 US states, the District of Columbia, and 5 US territories (744 female respondents [60.0%]; median age, 60 years [range, 24-92 years]; 266 African American or Black [hereafter referred to as Black] respondents [21.5%]; 186 Asian respondents [15.0%]; 232 Hispanic or Latinx [hereafter referred to as Latinx] respondents [18.7%]; 29 American Indian or Alaska Native, Native Hawaiian, or multiple races [hereafter referred to as other] respondents [2.3%]; and 527 White respondents [42.5%]). Compared with White respondents, Black respondents (odds ratio [OR], 6.13 [95% CI, 3.50-10.74]) and Latinx respondents (OR, 2.77 [95% CI, 1.49-5.14]) had greater odds of involuntary treatment delays, and Black respondents had greater odds of treatment delays greater than 4 weeks (OR, 3.13 [95% CI, 1.11-8.81]). Compared with White respondents, Black respondents (OR, 4.32 [95% CI, 2.65-7.04]) and Latinx respondents (OR, 6.13 [95% CI, 3.57-10.53]) had greater odds of food insecurity and concerns regarding food security (Black respondents: OR, 2.02 [95% CI, 1.34-3.04]; Latinx respondents: OR, 2.94 [95% CI, [1.86-4.66]), financial stability (Black respondents: OR, 3.56 [95% CI, 1.79-7.08]; Latinx respondents: OR, 4.29 [95% CI, 1.98-9.29]), and affordability of cancer treatment (Black respondents: OR, 4.27 [95% CI, 2.20-8.28]; Latinx respondents: OR, 2.81 [95% CI, 1.48-5.36]). Trusted sources of COVID-19 information varied significantly by race and ethnicity.

Conclusions and Relevance  In this survey of US adults with cancer, the COVID-19 pandemic was associated with treatment delay disparities and adverse social and economic effects among Black and Latinx adults. Partnering with trusted sources may be an opportunity to overcome such disparities.

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Article Information

Accepted for Publication: May 14, 2022.

Published: July 14, 2022. doi:10.1001/jamanetworkopen.2022.22009

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Patel MI et al. JAMA Network Open.

Corresponding Author: Manali I. Patel, MD, MPH, MS, Division of Oncology, Department of Medicine, Stanford University, 875 Blake Wilbur Dr, Stanford CA 94305 (manalip@stanford.edu).

Author Contributions: Dr Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Patel, Ferguson, Duron, Hlubocky, Infantado, Julian, Maingi.

Critical revision of the manuscript for important intellectual content: Patel, Ferguson, Castro, Pereira-Estremera, Armaiz-Peña, Hlubocky, Nuqui, Nortey, Steck, Bondy, Maingi.

Statistical analysis: Patel, Ferguson, Hlubocky, Bondy.

Obtained funding: Patel.

Administrative, technical, or material support: Patel, Castro, Pereira-Estremera, Armaiz-Peña, Hlubocky, Infantado, Nuqui, Julian, Nortey, Steck, Maingi.

Supervision: Patel.

Conflict of Interest Disclosures: Dr Pereira-Estremera reported receiving salary from Tiber Health Public Benefit Corp during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Patel’s research in this publication was supported, in part, by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award K23MD013474. Drs Castro and Armaiz-Peña were supported by the National Institutes of Health under award R21MD013674. Dr Patel and Ms Duron received research funding from the California Initiative to Advance Precision Medicine, which supported, in part, the research reported in this publication.

Role of the Funder/Sponsor: The National Institute on Minority Health and Health Disparities of the National Institutes of Health and the California Initiative to Advance Precision Medicine did not play a role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

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