Black cancer patients with COVID-19 disease were twice as likely to be hospitalized due to complications as compared with White patients in a large cohort of patients who tested positive for the coronavirus. Black patients also had a higher risk of visiting an emergency room.
Reports have emerged of possible racial disparities in COVID-19 and the severity and health consequences for minority populations in the United States. Understanding the reasons for higher negative impact of COVID-19 on health outcomes in the minority patient population might allow health care organizations and the scientific committee to efficiently target interventions, including vaccinations.
"In light of our findings, Black patients with cancer should exercise more caution and consistently use strategies to prevent COVID-19 infection," said lead author Chintan Pandya, MD, PhD, who led the study while working at Dana-Farber Cancer Institute and is now an assistant scientist at the Johns Hopkins Bloomberg School of Public Health. "When a vaccine for COVID-19 is available, it should be offered to high-risk patients first. For now, though, preventive measures are the most effective tool."
Pandya presented the findings of the study at the 2020 ASCO Quality Care Symposium.
Demographics, non-cancer comorbidities, cancer type, and treatment were captured from electronic health records. Hospitalization and emergency room visits were assessed from the time of laboratory confirmation of a COVID-19 diagnosis up to 30 days later. The most common cancers were gastrointestinal (105 patients) and other cancers (194 patients); 47 patients had any systemic cancer treatment in the past 30 days before the COVID-19 test.
Key Findings
In this retrospective, observational, quality-of-care study, the researchers examined electronic medical records for 557 cancer patients who tested positive for COVID-19 between March 1 and June 10, 2020, and had at least one visit in the past year at a single cancer center.
"We performed bivariate and multivariable logistic regression analysis to evaluate the association of race with outcomes after adjusting for confounding factors," said Pandya. The results of the analysis show that 14 percent (79 patients) were Black, and these patients accounted for 19 percent (18 patients) of hospitalizations and 27 percent (15 patients) of emergency room visits due to COVID-19. After controlling for demographics, comorbidities, and cancer variables, Black race was independently associated with a more than twofold higher risk of hospitalization when compared with White race. The mean length of hospital stay was 7.86 days.
The results are consistent with previous reports that U.S. minority populations experience greater illness severity and health consequences from COVID-19. However, similar data for patients with a cancer diagnosis is limited. This was a single-institution study and additional research is needed to determine whether these results are generalizable beyond the population studied, Pandya noted.
"Racial minority patients with cancer and their health care providers might need a high level of adherence to pandemic mitigation interventions to lower the extent of COVID-19 transmission and morbidity until a vaccine is widely available. When a vaccine appears, making it available for this high-risk patient population will be important," she said.
Next Steps
The researchers plan to compare patients with cancer who tested negative for COVID-19 with those who tested positive to further explore differences related to race.
"Future research should explore the health care system, patient, and disease mechanism contributing to the racial differences in the health outcomes of the COVID-19 patients with cancer," Pandya stated.
ASCO Expert Sonali M. Smith, MD, Professor of Medicine at the University of Chicago Medicine, commented: "Generally, people in racial and ethnic minority groups have been shown to have a higher incidence of COVID-19 and worse outcomes. This study shows a similar trend in Black patients with cancer who have COVID-19. It's important for health care providers, caregivers, and Black patients to be aware of the potential increased risk of hospitalization due to the virus."
Mark L. Fuerst is a contributing writer.
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