Analysis of Racial Disparity among U.S. Patients with Gynecologic Cancers and COVID-19 Infection

Abstract

Gynecologic cancer care has been affected by the COVID-19 pandemic. We studied the association of racial disparity and COVID infection in the care of patients with gynecologic cancers. To assess the association of racial disparity and COVID infection in gynecologic cancers the National Cancer Database (NCDB) was queried for the year 2020 for patients with histologically confirmed diagnosis of cervical, endometrial and ovarian cancers. Patients were divided into two cohorts based on COVID test result status and subsequently stratified based on race. Race/ethnicity was categorized as 1) non-Hispanic White (NHW), 2) non-Hispanic Black (NHB), and 3) Hispanic. Subjects with missing race/ethnicity information were excluded. Outcome variables were time from diagnosis to initiation of treatment (surgery, radiation therapy versus chemotherapy). Continuous and categorical variables were reported as median [interquartile range] and number [rate] and were compared using Mann-Whitney U test and Chi-Square test, respectively. Statistical software was used and the level of significance was set at 0.05. A total of 36,863 subjects with newly diagnosed gynecologic cancers in 2020 underwent had available COVID testing information (4,827 with cervical, 23,935 with endometrial, and 8,101 with ovarian cancer). 31,516 (85.5%), 4,735 (12.8%), and 612 (1.7%) of the population were NHW, NHB, and Hispanic, respectively. The overall rate of COVID infection was the highest in NHB (6.9%), followed by Hispanic (5.6%) and NHW (5.4%), p < 0.001. Patients with cervical cancer had the highest rate of COVID infection (7.3%), followed by ovarian (5.6%) and endometrial (5.2%), p < 0.001. Non-Hispanic Black women with cervical cancer had the highest rate of infection (8.6%). Median time from diagnosis to first surgical procedure was highest in COVID positive NHB subjects (52 [IQR 20-91] in NHB, 41 [IQR 12-67] in NHW, and 40 [IQR 9-58] in Hispanics, p = 0.02). Median time from diagnosis to first radiation treatment was also highest in COVID positive NHB subjects (83 [IQR 29-107] in NHB, 52 [IQR 17-67] in NHW, and 39 [IQR 9-51] in Hispanics, p = 0.04). There was not racial or ethnic disparity in time from diagnosis to the first systemic therapy. COVID pandemic has substantially impacted gynecologic cancer care in the United States and exacerbated existing healthcare disparities. Members of African American community with gynecologic cancers have been affected the most compared to other racial groups, both in terms of COVID infection rates and delays in receiving care. Further study is warranted to understand impact on long-term cancer related outcomes.