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

Abstract

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.

Conflict of interest statement

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.

Figures

Figure.. Subgroup Analysis of Anticancer Drug Therapy Delay Among Patients With COVID-19

Zip code–level variables are binary variables, defined as higher than median vs lower than median. BMI indicates body mass index, calculated as weight in kilograms divided by height in meters squared; GI, gastrointestinal; GU, genitourinary; OR, odds ratio.