Disparities in cancer care delivery during the COVID-19 pandemic: An update of a prospective, cross-sectional study.

Abstract

136 Background: Impact of COVID19 on cancer care delivery and outcomes remains unknown. Few trials have investigated patients’ perceived risks and benefits, and cancer care delivery (CCD) alterations related to COVID19. We sought to identify differences on behaviors and social determinants of health in Hispanics and other underrepresented populations (H/UP) compared to the general population (GP). Methods: An IRB-approved validated 27-item questionnaire was offered in English and Spanish to all pts receiving cancer care at participating cancer centers over a 6 month period. Examined variables included demographic information, social risk and behavioral factors, preferred sources of health information, and overall satisfaction with CCD during the pandemic. Results: A total of 245 pts were enrolled in the study. Compared to GP, H/UP’s perceived risk of COVID19 was higher with 92.4% vs 85.2% (p = 0.000) more likely to cancel or avoid social gatherings and 69.2% vs 32.1% more likely to change daily routine. H/UP appeared more concerned with personal and financial safety; if unable to find work/get paid for 2 weeks, 24.1% H/UP vs 13% GP would struggle to keep up with expenses. 33.7% H/UP vs 8.6% GP had concerns on ability to secure food and consider COVID19 a major threat to their health (63.9% vs 42.6%, p = 0.003) and financial situation (61.4% vs 35.8%, p = 0.001). H/UP’s perceived benefits of protective measures is higher with 97.4% vs 90.7% routinely practicing social distancing (SD) and 92.8% vs 64.2% in agreement with punitive actions for not following SD. Analysis demonstrated no significant difference by gender, level of education, marital status, however Hispanic ethnicity and Spanish as primary language were significant variables (p = 0.000) in perceived risks and satisfaction with CCD. No major differences were noted on sources of health information although more H/UP relied on social media (26.5% vs 24.7%). H/UP appeared more skeptical about availability and safety of targeted vaccines (28.2% vs 14.8%, p = 0.001). H/UP were less satisfied with CCD during the pandemic (72.1% vs 82.1%, p = 0.024) and also perceived CCD alterations (19.2% vs 7.4%). Conclusions: COVID19-related societal, financial, health and personal fears are increased in H/UP which likely negatively affects quality of life of these at-risk populations. H/UP’s trust in SD recommendations is heightened although linguistically and culturally appropriate information may be deficient. H/UP were more skeptical of the safety and availability of the vaccine, which is consistent with recent reports suggesting deeper fears of experimentation. Interventions aimed to decrease these differences could incorporate standard communications with special attention to social media.