Disparities in Cancer Outcomes from the COVID-19 Pandemic

PROJECT SUMMARY Background: A nationwide moratorium was instituted on all elective clinical services in March 2020 to slow the transmission of COVID-19, safeguard patients, and preserve healthcare resources. This led to a major disruption in cancer screening and diagnostic procedures. Among Veterans nationwide, we found a significant and persistent decrease in the detection of new cancers. Without routine screening and easy access to medical care, cancer patients may go undetected, only presenting when the cancer is beyond curative therapy. The unprecedented COVID-related disruptions may also have exacerbated preexisting disparities in cancer outcomes among disadvantaged populations. Significance: With no information on the impact of the COVID-19 pandemic on cancer outcomes or changes in outcome disparities, health systems cannot identify populations at risk or implement programs to mitigate current deficits. We need a comprehensive evaluation of how pandemic disruptions to cancer care are affecting cancer outcomes. In addition, we need a surveillance system to assess changes in cancer outcomes over time, as the impacts of the pandemic evolve and mitigation efforts are implemented. We hypothesize that cancer outcomes in the COVID era will worsen, with higher rates of 1) mortality, 2) cancer recurrence, and 3) metastatic disease at presentation. Additionally, disparities in the above outcomes will be exacerbated in the COVID era among patients in the following vulnerable subgroups: female, age > 60 years, Black, Latino, rural, or in zip codes with lower SES. We will evaluate these hypotheses through the following Specific Aims: 1) Identify differences in cancer outcomes between the COVID and pre-COVID eras by cancer type. 2) Identify disparities in cancer outcomes among disadvantaged populations in the COVID era. Methodology: Using detailed, nationwide, patient-level data from the Veterans Administration Informatics and Computing Infrastructure (VINCI), we will evaluate changes cancer outcomes from the pre-COVID (March 1, 2018 through February 29, 2020) to COVID (March 1, 2020 to February 28, 2025) era. Poisson and Cox Proportional Hazards models will be used to analyse the change from the pre-COVID to COVID era by cancer type and among vulnerable subgroups. Next Steps/Implementation: The VINCI dataset offers a unique opportunity to provide near real-time assessment of the impacts of ongoing disruptions in new cancer identification on cancer outcomes and the exacerbation of existing disparities in a healthcare crisis. This project will allow us to develop actionable data and a system of surveillance to guide interventions that address the identified disparities. Using the validated system developed in this project, we will expand to populations outside of the VA and initiate interventional studies to mitigate or eliminate the identified disparities.