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Researchers found patients who were Black or Hispanic were far more likely than white patients to see care postponed for more than four weeks. The delays raise the risk for poor outcomes.
The COVID-19 pandemic led to delays in cancer care, but Black and Brown patients were much more likely to have longer delays for treatment.
Researchers examined how the pandemic affected cancer treatment and identified glaring disparities, according to a study published in Jama Network Open earlier this month.
Virtually everyone experienced delays in cancer care during the pandemic, said Manali Patel, the corresponding author of the study and assistant professor of oncology at Stanford Medicine.
“The extent of the delay was much worse for Black and Brown folks,” Patel said in an interview with Chief Healthcare Executive.
Black patients were six times more likely than white patients to experience cancer treatment delays that exceeded four weeks, the study found. Latinx adults were nearly three times more likely than white adults to see treatment delayed for more than four weeks.
Those delays among patients who were diagnosed with cancer are troubling, since they suggest that one or more courses of treatment were delayed or canceled, the researchers said. Most of the participants in the study were getting treatment every two to three weeks, and some were getting chemotherapy on a daily basis.
If cancer treatment is delayed, patients are more likely to suffer complications, Patel said. Delays that long can increase the risk of death, she said.
“We don’t like delays by even one or two weeks,” Patel said. “If you miss a whole course of therapy, that will have a higher risk of poor outcomes.”
‘There’s no clear answer’
Patients didn’t just experience delays in treatment. Some also had to wait longer for imaging, and the delay in tests also can affect the course of treatment. “It was this cascading effect of delays,” Patel said.
When asked why there was such a significant disparity in delays for Black and Brown patients, Patel said, “There’s no clear answer why.”
After all, these aren’t people that were reluctant to see providers or lacking doctors. “They were in the system,” she said. “They were receiving treatment.”
Black and Latinx patients also were more likely to have “extreme concerns” of financial problems, including food and housing insecurity, and fears that they wouldn’t be able to afford their cancer treatment.
“It all interplays in the greater impact of the pandemic on our black and brown communities,” Patel said.
Researchers examined survey results from 1,240 participants who came from all 50 states, Washington, D.C., and all five U.S. territories. The median age of the participants was 60 years old, but the ages ranged from 24 to 92. So the results of the study suggest the disparities occurred across the nation and weren’t tied to a specific region.
‘Make a choice to not have delays’
Healthcare leaders should take a close look at their cancer patients to see if there are gaps or delays in treatment among certain groups.
To avoid having patients endure delayed cancer care, “you need to make a choice to not have delays,” Patel said.
When asked what health systems can do to address disparities, Patel said they start by “identifying that you have a problem.” Hospitals and health systems must look at “who is getting care and who may be getting lost,” Patel said.
Health systems should also review what may be causing disparities. If patients are shifting to telemedicine for some services, Patel said health systems need to understand “not everyone has the same access to telemedicine.”
Some cancer patients, particularly older patients, may not be comfortable with the technology, she said. Some also may not have access to video telehealth services. The U.S. Department of Health and Human Services released a study identifying disparities in video telehealth services among Black, Latino and Asian patients, along with those with lower incomes.
Health systems could work more collaboratively to improve cancer care. If a hospital is seeing delays in treatment, the provider could reach out to another hospital to work together and see if they could accommodate patients with delays. Patel acknowledged that’s not always acceptable as a business model, since a hospital would be losing revenue, and such arrangements would need to be approved by insurers.
Still, hospitals need to be sure patients aren’t getting delays in cancer care, both to offer patients the best care possible and for the sake of their own finances. If cancer treatments are delayed, patients will face greater risks of complications and hospitals will spend more to care for them, she noted.
“The right thing also saves costs,” she said.
Since disparities in healthcare existed long before the pandemic, Patel said she wasn’t shocked by the results of the study. But she hopes health systems take notice of the findings of disparities in cancer care affecting Black and Latinx patients.
“Hopefully getting this information will get people to see there are really bad inequities in cancer care,” Patel said.
“There’s a silver lining of hope if we pay attention and choose to overcome these disparities.”