Impact of COVID-19 on Disparities in Cancer Outcome Spans Various Groups of Patients

Recent research showed that patients with Medicaid are more likely than commercially insured patients to have worsened end-of-life experience and that Black patients with breast cancer fare worse than other ethnic groups when it comes COVID-19 outcomes.

Two study abstracts presented at the American Society of Clinical Oncology annual meeting are offering insight into how the COVID-19 pandemic is exacerbating disparities in outcomes among patients with cancer, including for patients of different ethnicities and economic status.

The pair of abstracts revealed that patients with Medicaid are more likely than commercially insured patients to have worsened end-of-life experience and that Black patients with breast cancer fare worse than other ethnic groups when it comes COVID-19 outcomes.

Disparities in health outcomes when it comes to race/ethnicity and income have long been studied, and since the COVID-19 pandemic made its way through the country last year, concerns over worsening disparities for these patients have loomed.

With Black and Hispanic patients having a higher risk of acquiring the virus that causes COVID-19, researchers of the first study abstract aimed to see how 1000 patients of different ethnicities with breast cancer fare after contracting the disease.1

Across all ethnic groups, Black patients were significantly more likely to have more severe illness and die of the virus. Black patients were more likely than White and Hispanic patients to be hospitalized for COVID-19 (49% vs 34% vs 34%, respectively) and require mechanical ventilation (9% vs 3% vs 5%, respectively). Both 30-day (9% vs 6% vs 4%, respectively) and total mortality (12% vs 8% vs 5%, respectively) were higher among Black patients than White and Hispanic patients.

“This is the largest study to show significant differences in COVID-19 outcomes by racial/ethnic groups of women with [breast cancer]. The adverse outcomes in [non-Hispanic Blacks] could be due to higher moderate to severe COVID-19 at presentation and preexisting co-morbidities,” wrote the researchers, noting that more than half (54%) of the Black patients in their study had obesity and 31% had diabetes.

The researchers added: “[Hispanics] did not have worse outcomes despite having more active disease and recent anti-cancer therapy, including with cytotoxic chemotherapy – potentially due to younger age and nonsmoking status.”

Hispanics were significantly younger than the other patients, with a median age 54 years compared with 63 years for White patients and 62 years for Black patients. Seventy-eight percent of Hispanics reported being never smokers compared with 62% of White patients and Black patients.

The study also included a small group of Asian American and Pacific Islander (AAPI) patients (n = 35), who had more severe COVID-19 and inferior outcomes compared with White patients. The authors noted that these differences were statistically significant despite the small sample size of AAPI patients.

The second abstract presented at the conference showed that the impact of COVID-19 on cancer outcomes also varies based on economic status, finding that patients with cancer on Medicaid are more likely than commercially insured patients with cancer to die at home without hospice.2

The findings come from over 600 patients in Washington, the earliest COVID-19 epicenter in the country. Compared with commercially insured patients, those on Medicaid were 15.8% more likely to die at home without the end-of-life care.

“Following COVID, Medicaid patients place of death shifted from hospital to homes, but without an increase in the use of home hospice services,” explained the researchers. “In contrast, place of death and hospice use among commercial patients did not significantly change. This widening disparity in home deaths without hospice services raises concerns that the pandemic disproportionately worsened end of life experience for low income patients with cancer.”

Prior to the pandemic (2017-2019), patients with Medicaid were more likely than younger patients with commercial insurance to die in the hospital. However, between March and June 2020, the probability of older patients dying in the hospital dropped by 12% and the probability of these patients dying at home without hospice increased by 11% compared with the period before COVID-19.

References

1. Nagaraj G, Accordino M, French B, et al. Racial and ethnic disparities among patients with breast cancer and COVID-19. J Clin Oncol. 2021;39: (suppl 15; abstr 6500). doi:10.1200/JCO.2021.39.15_suppl.6500

2. Panattoni L, Li L, Sun Q, et al. Medicaid patients more likely to die at home without hospice during the pandemic versus before, exacerbating disparities with commercially insured patients. J Clin Oncol. 2021;39 (suppl 15; abstr 6502). doi: 10.1200/JCO.2021.39.15_suppl.6502