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Factors Associated With Cancer Treatment Delay Among Patients Diagnosed With COVID-19

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

Question  What are the factors associated with cancer treatment delay among patients with test results positive for SARS-CoV-2?

Findings  In this cohort study using data from 3028 patients in a large COVID-19 oncology data registry, multiple different patient demographic factors, such as race and ethnicity, underlying primary malignant neoplasm (diagnosis and extent of spread), multimorbidity, geographic location, receipt of COVID-19 vaccine, severity of COVID-19 infection, and timing of COVID-19 diagnosis, were associated with delays in cancer treatment.

Meaning  These findings suggest that some health disparities may have been exacerbated during the pandemic as an effect of cancer treatment delay.


Importance  The COVID-19 pandemic led to disruptions in delivery of cancer treatments; factors associated with treatment delay among patients with cancer who contract COVID-19 need further characterization.

Objective  To assess the associations of patient factors, social determinants of health, severity of COVID-19, and timing of COVID-19 diagnosis with the risk of treatment delay.

Design, Setting, and Participants  This prospective cohort study was conducted from March 2020 through July 2021 at 60 academic and community medical practices in the United States. Participants included patients with any cancer diagnosis who were scheduled for treatment and contracted COVID-19. Data were analyzed in February 2022.

Exposure  Positive test result for SARS-CoV-2.

Main Outcomes and Measures  The main outcomes were treatment delay, defined as more than 14 days between the date originally planned for treatment and the date of initiation of therapy, or discontinuation of therapy. Multivariable analyses were used to assess outcomes.

Results  A total of 3028 patients (1470 patients [49%] aged ≥65 years; 1741 [58%] women) were included in the registry. With 962 of 2103 patients (46%) experiencing anticancer drug delay or discontinuation, delays were higher among Black patients compared with White patients (odds ratio [OR], 1.87; 95% CI, 1.40-2.51), Hispanic or Latino patients compared with non-Hispanic or Latino patients (OR, 1.91; 95% CI, 1.34-2.72), patients with 2 or more comorbidities compared with patients with 0 to 1 (OR, 1.23; 95% CI, 1.00-1.53), patients with metastatic disease rather than locoregional disease (OR, 1.63; 95% CI, 1.29-2.05), and patients who experienced COVID-19 complications compared with those who did not (OR, 1.52; 95% CI, 1.24-1.86). Residing in an area with a higher proportion of residents reporting Hispanic or Latino ethnicity (OR, 0.76; 95% CI, 0.60-0.95) and contracting COVID-19 later in the pandemic, compared with those who were infected in March to June 2020, (eg, January to March 2021: OR, 0.38; 95% CI, 0.26-0.53) were associated with lower likelihood of drug therapy delay. A total of 95 of 202 patients (47%) experienced delay or discontinuation of radiation treatment, with having 2 or more comorbidities associated with delay (OR, 2.69; 95% CI, 1.20-6.20). Higher local-area median household income was associated with lower likelihood of radiation treatment delay (OR, 0.41; 95% CI, 0.17-0.94). There were 89 of 125 patients (71%) who experienced surgical treatment delay, and delays were higher among patients in the South compared with those in the Midwest (OR, 9.66; 95% CI, 2.14-52.3). Interestingly, patients with 2 or more comorbidities, compared with those with 0 to 1, experienced lower likelihoods of surgical treatment delay (OR, 0.26; 95% CI, 0.07-0.88).

Conclusions and Relevance  Our findings suggest that individual patient factors, social determinants of health, and COVID-19 severity and diagnosis date were associated with exacerbated health disparities during the pandemic in regards to cancer treatment delay.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: June 13, 2022.

Published: July 28, 2022. doi:10.1001/jamanetworkopen.2022.24296

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

Corresponding Author: Samyukta Mullangi, MD, MBA, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (smullangi13@gmail.com).

Author Contributions: Drs Mullangi and Hershman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mullangi, Aviki, Chen, Hershman.

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

Drafting of the manuscript: Mullangi, Chen, Hershman.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Chen.

Obtained funding: Mullangi, Hershman.

Administrative, technical, or material support: Mullangi.

Supervision: Aviki, Hershman.

Conflict of Interest Disclosures: Dr Robson reported receiving personal fees from Research to Practice, Intellisphere, MyMedEd, Change Healthcare, and Physician’s Education Resources; grants from AstraZeneca, Merck, and Pfizer; editorial services from AstraZeneca, Novartis, and Pfizer; and serving as an unpaid consultant for Artios Pharma, AstraZeneca, Daiichi-Sankyo, Epic Sciences, Merck, Pfizer, Tempus Labs, and Zenith Pharma outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by a Conquer Cancer 2021 American Society of Clinical Oncology (ASCO) Registry Research Grant.

Role of the Funder/Sponsor: ASCO was involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.

AMA CME Accreditation Information

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:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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