Care Coordination for Complex Cancer Survivors in an Integrated Safety-Net System

PROJECT SUMMARY/Abstract: The COVID-19 pandemic presents a new and significant health threat for cancer survivors. Cancer survivorsare often immuno-compromised from cancer treatment and thus may have higher risks of contracting COVID-19 in addition to adverse outcomes related to cancer. Early findings among COVID patients show thatindividuals with a history of cancer have a higher risk of severe events that resulted in admittance to theintensive care unit, ventilation support, or premature death. COVID-19 also disproportionately affectsvulnerable, underserved, and ethnic minority populations; many of these receive their health care at safety-nethealth systems such as Parkland. Those who are African American and Latino or who are uninsured are alsomore likely to have underlying medical conditions such as diabetes, heart conditions, asthma, severe obesity,liver disease. In addition to increased risk of COVID-19 infection, cancer patients may also be experiencingdisruptions and changes to their clinical care routines due to COVID-19 shutdown and work-from-homeorders; survivors may experience delays in cancer treatment and follow-up care. Thus, racial/ethnic minorityand underserved cancer survivors who also have co-occurring chronic conditions represent the 'perfect storm'of risk factors for significant impacts on health outcomes as well as increasing health disparities.With this supplement, we will examine the impact of COVID-19 on care for vulnerable cancer survivors withhigh clinical risk further exacerbated by multiple chronic conditions, who are predominantly racial/ethnicminorities, uninsured, and served by a safety-net health system. Our specific aims are:Aim 1: Assess the impact of COVID-19 on the overall health and wellbeing of cancer survivors. Using amixed-methods approach (patient surveys and semi-structured interviews), we will assess the COVID-19effect on patients' physical, emotional, and mental health, financial impact, and coping.Aim 2: Assess the impact of COVID-19 on cancer survivors' access to cancer and non-cancer treatment andhealthcare utilization. We will capture how the pandemic impacted the delivery of cancer care and otherhealthcare services in this integrated safety-net system. We will examine whether there were treatment delaysrelated to cancer or other co-morbidities, challenges accessing care during this time, and the quality of caredelivered. Additionally, we will document and quantify the nature of COVID-19 encounters among our cohortof complex cancer survivors, using electronic health record (EHR) data extraction and analysis.These aims directly leverage existing research methods from the parent R01, adding new covariates andpatient-reported data specific to the COVID-19 experience. Given that COVID-19 has changed the caredelivery process and there is an expectation of other cycles of the disease, our findings will guide stakeholdersin the development of new and alternative care strategies that may mitigate impact among vulnerable,complex cancer survivors.