Columbia University Minority/Underserved Site NCI Community Oncology Research Program

Cancer patients are at particular risk for COVID-19 infection and adverse outcomes associated with the disease. A nationwide cohort study of over 1000 cancer patients diagnosed with COVID-19 reported a 13% mortality rate due to complications, dramatically higher than that seen in subjects without cancer. In addition to the direct impact of COVID-19 infection in cancer patients, the COVID-19 pandemic has resulted in a reallocation of hospital and medical resources to the care of patients with COVID-19. This resource strain has resulted in delays and discontinuation of treatments for chronic diseases such as cancer. Delays and interruptions in chemotherapy, radiotherapy and surgery are common among cancer patients. Our preliminary data strongly suggests that minority and socioeconomically disadvantaged cancer patients are at particular risk for interruptions in their cancer care. The overarching goal of this proposal is to determine the interplay of race and neighborhood socioeconomic factors on cancer care delivery for oncology patients during a period of wide community spread of COVID-19. We will utilize large scale datasets to analyze factors associated with COVID19 infection among a racial and socioeconomically diverse group of cancer patients and perform quantitative surveys in this population to determine how COVID-19 has impacted receipt of cancer care and enrollment onto clinical trials. Specifically, we will link data from 2,000 patients with cancer diagnosed between December 3, 2019 and August 1, 2020 and receiving cancer treatment at Columbia University Irving Medical Center in New York City to census and real estate tax assessment data to determine the association between race and neighborhood socioeconomic status and COVID-19 infection rates. We will then survey a diverse subset of these cancer patients (n = 150, 75 non-Hispanic whites and 75 Hispanic and black) to quantitatively assess knowledge of, attitudes toward, and behaviors related to SARS-CoV-2 and determine how community social and economic indicators, stress, coping style and social support have influenced cancer treatment delays and clinical trial participation during the COVID-19 pandemic. We hypothesize that minority cancer patients and those residing in neighborhoods with low socioeconomic status are increased risk for COVID-19 infection and are more likely to experience treatment delays and disruptions of their cancer care and clinical trial participation. The proposed work will comprehensively determine how racial and socioeconomic factors influence COVID-19 infection and care delivery among cancer patients. We will leverage our unique population of racial and socioeconomically diverse patients from a cancer center at the epicenter of COVID-19 infection in New York City. We anticipate that data from these studies will identify demographic factors associated with a particularly high risk for COVID19 infection and cancer treatment alterations that may impact survival. Ultimately, these data will be utilized to develop pragmatic interventions to help reduce the burden of COVID-19 on cancer care in vulnerable and minority populations.