The Quality Care Symposium will be held virtually this year on October 9 and 10. This symposium from the American Society of Clinical Oncology (ASCO) brings together health care experts to share strategies for cancer care issues and integrating these methods into patient care.
A key focus for this year's meeting is the impact of the COVID-19 pandemic on people with cancer, particularly those people who are most affected by cancer disparities. There are 3 studies that will be highlighted at the symposium that investigate the impact of COVID-19 during the start of the pandemic:
- Black and Hispanic people with cancer used telehealth care less often than white people with cancer during the COVID-19 pandemic
- Black people with cancer are at increased risk for COVID-19 hospitalization, emergency care
- Hispanic and Black people with cancer at higher risk of COVID-19
You can learn more about research from this symposium by following the #ASCOQLTY20 hashtag on Twitter.
Black and Hispanic people with cancer used telehealth care less often than white patients during the COVID-19 pandemic
A study in New York City has found that fewer Black and Hispanic people with cancer used telehealth visits compared with white people with cancer as this year's COVID-19 pandemic unfolded, despite substantial growth in the number of patients who used telehealth. Telehealth has become an important way of continuing medical care during the pandemic, giving patients access to medical experts without risk of exposure to the SARS-CoV-2 virus, the virus that causes COVID-19 disease. Telehealth visits in this study include appointments conducted by phone and over video.
The researchers studied data on race, ethnicity, and visit type from electronic medical records of people with cancer in the Mount Sinai Health System, which includes a cancer center and 8 other clinics across New York City. This analysis included 7,681 people who had a telehealth visit. Of these, 5,857 (76%) were video visits and 1,824 (24%) were by phone.
Researchers examined the number of patients who had video visits or phone encounters from March 1 to June 1, 2020. During the study period, 48% of white patients, 19% of Black patients, 6% of Hispanic patients, and 7% of Asian patients used telehealth as part of their cancer care. For video visits, the percentages of patients were 50% of white patients, 17% of Black patients, 5% of Hispanic patients, and 8% of Asian patients. For patients with phone encounters, it was 43% white, 23% Black, 7% Hispanic, and 6% Asian. For comparison, in 2019, the cancer center's patient population was 42% white, 23% Black, 14% Hispanic, and 7% Asian, and less than 1% of all patients used telehealth.
This analysis shows that a lower percentage of Black and Hispanic people were using telehealth, especially video visits, than were in the center's total patient population. The researchers are now exploring ways to improve patients' access to telehealth. As the pandemic persists, it is important to identify barriers to its use so far and solutions for the future. It is likely that telehealth will become more regularly used in medical practice even after the pandemic ends.
What does this mean? Since the COVID-19 pandemic began, there has been widespread concern about whether people with cancer would be able to receive their necessary medical care. This study provides evidence that more efforts are needed to ensure that telehealth care, as a main alternative to in-person care, is accessible to people already at risk for disparities in cancer care, especially Black and Hispanic patients.
"In a world where telehealth is needed because patients don't have in-person access to routine and follow-up cancer care—such as during the COVID-19 pandemic—it is important to recognize the gaps that exist among racial and ethnic minorities. We know that many patients have not been seeking medical attention or continuing routine care because of fear about the virus."
— lead study author Cardinale B. Smith, MD, PhD
Mount Sinai Health System
New York, New York
Black people with cancer are at increased risk for COVID-19 hospitalization, emergency care
An analysis of electronic medical record data from Boston, Massachusetts, has found that Black people with cancer who tested positive for COVID-19 were twice as likely to be hospitalized due to the virus compared with white people who also had both cancer and COVID-19. Black people with cancer and COVID-19 also had a higher risk of having to visit the emergency department (ED).
In this study, researchers looked at data from electronic medical records from the Dana-Farber Cancer Institute. They examined data for 557 people with cancer who tested positive for COVID-19 between March 1 and June 10, 2020 and had at least 1 visit in the past year at the cancer center. Hospitalization due to COVID-19 and ED visits were evaluated up to 30 days after the COVID-19 diagnosis.
While 14% (79) of the patients in this study were Black, they accounted for more hospitalizations and visits to the ED. In the study, there were 56 people who visited the ED, and 15 (27%) were Black. There were 96 people who were hospitalized, and 18 (19%) were Black. After statistical analysis of the data, the researchers found that Black race alone carried twice the risk of hospitalization compared with being white with the same 2 health conditions.
What does this mean? This study adds to the growing scientific evidence that Black people experience severe health effects from COVID-19 at a higher rate, including those with cancer.
"In light of these findings, Black patients with cancer should exercise more caution and consistently use strategies to prevent COVID-19 infection. When a vaccine for COVID-19 is available, it should be offered to high-risk patients first. For now, though, preventive measures are the most effective tool."
— lead study author Chintan Pandya, PhD
Johns Hopkins Bloomberg School of Public Health
Hispanic and Black people with cancer at higher risk of COVID-19 infection
An analysis of U.S. electronic health records has shown that Hispanic people with cancer are more than 5 times more likely to be diagnosed with COVID-19 than patients who are not Hispanic. And, Black people with cancer are nearly 2 times more likely to be diagnosed with COVID-19 than white people with cancer.
For this study, researchers used patient data from the CancerLinQ Discovery health technology platform. CancerLinQ, which is developed by ASCO, collects electronic health record information from oncology practices throughout the United States. The CancerLinQ database has de-identified records of nearly 2 million people with cancer.
For the analysis, records of 477,613 people with cancer from January to August 2020 were examined. There were 965 people diagnosed with COVID-19 in the data group. In addition to finding the higher risk of COVID-19 related to ethnicity and race, the researchers found that people with hematologic cancers, such as leukemia, lymphoma, and myeloma, were about 1.4 times more likely to be diagnosed with COVID-19 than were people with solid tumors. Of the 965 people with COVID-19, 52 (5.4%) died, but the data examined in this study did not specify what caused these deaths.
What does this mean? Evidence continues to build that COVID-19 causes more harm to specific, at-risk groups of people. This study highlights specific risks for people with cancer in specific ethnic and racial groups as well as those with a diagnosis of a hematologic cancer.
"Patients with cancer are, unfortunately, faced with balancing cancer treatments with the risk of developing COVID-19. This research, while preliminary, will hopefully help patients and providers understand who's most at risk for COVID-19 and plan cancer treatment accordingly."
— lead study author Robert S. Miller MD, FACP, FASCO
To read the individual study abstracts and the disclosure information of authors, visit ASCO's website about the 2020 Quality Care Symposium. In order from the top, the abstract numbers are #87, #122, and #84.