Disparities in Cancer Outcomes from the COVID-19 Pandemic

COVID-19 大流行导致癌症结果存在差异

基本信息

批准号：
10726225
负责人：
Brian Robert Englum
金额：
$ 23.18万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-18 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10726225
关键词：
Address Affect Age Black race Businesses COVID-19 COVID-19 disparity COVID-19 pandemic COVID-19 pandemic effects Cancer Patient Caring Cessation of life Characteristics China Clinical Services Colonoscopy Computerized Medical Record Country Cox Proportional Hazards Models Data Data Set Databases Detection Diagnosis Diagnostic Diagnostic Procedure Disease Disparate Disparity Disparity population Drops Early Diagnosis Early identification Education Ethnic Origin Evaluation Female Fright Future Geographic Locations Geography Health system Healthcare Healthcare Activity Healthcare Systems Hospitals Individual Informatics Infrastructure Inpatients Intervention Intervention Studies Italy Latino Location Malignant Neoplasms Medical Methodology Modeling Newly Diagnosed Outcome Outpatients Patient risk Patients Policy Maker Population Populations at Risk Procedures Race Recurrent Malignant Neoplasm Research Resources Risk Factors Rural SARS-CoV-2 B.1.1.529 SARS-CoV-2 B.1.617.2 SARS-CoV-2 transmission Screening for cancer Screening procedure Subgroup System Testing Time United States United States Department of Veterans Affairs Vaccination Veterans Vulnerable Populations access disparities cancer care cancer diagnosis cancer health disparity cancer recurrence cancer type coronavirus disease curative treatments data infrastructure design experience future outbreak health care availability low socioeconomic status mortality news operation outcome disparities pandemic disease pandemic impact patient subsets preservation programs repository routine screening rural area screening sex simulation transmission process

项目摘要

PROJECT SUMMARY Background: A nationwide moratorium was instituted on all elective clinical services in March 2020 to slow the transmission of COVID-19, safeguard patients, and preserve healthcare resources. This led to a major disruption in cancer screening and diagnostic procedures. Among Veterans nationwide, we found a significant and persistent decrease in the detection of new cancers. Without routine screening and easy access to medical care, cancer patients may go undetected, only presenting when the cancer is beyond curative therapy. The unprecedented COVID-related disruptions may also have exacerbated preexisting disparities in cancer outcomes among disadvantaged populations. Significance: With no information on the impact of the COVID-19 pandemic on cancer outcomes or changes in outcome disparities, health systems cannot identify populations at risk or implement programs to mitigate current deficits. We need a comprehensive evaluation of how pandemic disruptions to cancer care are affecting cancer outcomes. In addition, we need a surveillance system to assess changes in cancer outcomes over time, as the impacts of the pandemic evolve and mitigation efforts are implemented. We hypothesize that cancer outcomes in the COVID era will worsen, with higher rates of 1) mortality, 2) cancer recurrence, and 3) metastatic disease at presentation. Additionally, disparities in the above outcomes will be exacerbated in the COVID era among patients in the following vulnerable subgroups: female, age > 60 years, Black, Latino, rural, or in zip codes with lower SES. We will evaluate these hypotheses through the following Specific Aims: 1) Identify differences in cancer outcomes between the COVID and pre-COVID eras by cancer type. 2) Identify disparities in cancer outcomes among disadvantaged populations in the COVID era. Methodology: Using detailed, nationwide, patient-level data from the Veterans Administration Informatics and Computing Infrastructure (VINCI), we will evaluate changes cancer outcomes from the pre-COVID (March 1, 2018 through February 29, 2020) to COVID (March 1, 2020 to February 28, 2025) era. Poisson and Cox Proportional Hazards models will be used to analyse the change from the pre-COVID to COVID era by cancer type and among vulnerable subgroups. Next Steps/Implementation: The VINCI dataset offers a unique opportunity to provide near real-time assessment of the impacts of ongoing disruptions in new cancer identification on cancer outcomes and the exacerbation of existing disparities in a healthcare crisis. This project will allow us to develop actionable data and a system of surveillance to guide interventions that address the identified disparities. Using the validated system developed in this project, we will expand to populations outside of the VA and initiate interventional studies to mitigate or eliminate the identified disparities.

项目概要背景：2020 年 3 月在全国范围内暂停所有选择性临床服务，以减缓传播 COVID-19、保护患者并保护医疗资源。这导致了一场重大癌症筛查和诊断程序的中断。在全国退伍军人中，我们发现了一个重要的新癌症的检出率持续下降。无需常规筛查且易于获取由于医疗护理，癌症患者可能未被发现，只有当癌症无法治愈时才会出现。与新冠病毒相关的前所未有的破坏也可能加剧了癌症方面先前存在的差异弱势群体的成果。意义：没有关于 COVID-19 大流行对癌症结果或变化的影响的信息在结果差异方面，卫生系统无法识别面临风险的人群或实施缓解方案当前的赤字。我们需要全面评估流行病对癌症治疗的干扰程度影响癌症结果。此外，我们需要一个监测系统来评估癌症结果的变化随着时间的推移，随着大流行影响的演变和缓解措施的实施。我们假设新冠病毒时代的癌症结果将会恶化，1) 死亡率、2) 癌症复发率和 3) 更高就诊时患有转移性疾病。此外，上述结果的差异将在新冠病毒时代以下弱势群体患者：女性、年龄 > 60 岁、黑人、拉丁裔、农村、或 SES 较低的邮政编码。我们将通过以下具体目标评估这些假设：1) 按癌症类型确定新冠疫情和新冠疫情之前的癌症结果之间的差异。 2）识别新冠病毒时代弱势群体癌症结果的差异。方法：使用来自退伍军人管理局信息学的详细的、全国性的、患者级别的数据和计算基础设施 (VINCI)，我们将评估新冠疫情前癌症结果的变化（3 月 1 日） 2018年至2020年2月29日）到新冠肺炎（2020年3月1日至2025年2月28日）时代。泊松和考克斯比例风险模型将用于分析癌症从新冠疫情前到新冠疫情时代的变化类型和弱势亚群体之间的关系。后续步骤/实施：VINCI 数据集提供了一个独特的机会来提供近乎实时的数据评估新癌症识别的持续中断对癌症结果的影响以及医疗保健危机中现有差距的加剧。该项目将使我们能够开发可操作的数据以及指导解决已发现的差异的干预措施的监督系统。使用经过验证的在该项目中开发的系统中，我们将扩展到 VA 以外的人群并启动介入治疗旨在减轻或消除已发现的差异的研究。