Disparities in Cancer Outcomes Due to COVID-19—A Tale of 2 Cities

Abstract

A Tale of 2 CitiesThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease coronavirus 2019 (COVID-19), has ravaged the United States since the first case was documented in Washington State in January 2020.By early March, the first case of COVID-19 was confirmed in New York.From the very first case to present day, it has become increasingly clear that densely populated cities bear the brunt of this disease.In New York City as of July 7, 2020, approximately 214 000 cases and 18 000 deaths have been documented.While COVID-19 has had a worldwide impact, suspicions about its disproportionate effects on minority populations have now been confirmed with the release of data stratified by race and ethnicity.Within New York, we are witnessing 2 distinct trajectories and risk groups defined along the lines of race and socioeconomic status.As of July 7, 2020, the age-adjusted death rate for Hispanic and Black patients is twice that of White patients. 1Additionally, the Bronx, Queens, and Brooklyn each have twice the number of cases per 100 000 individuals as Manhattan and 3 to 4 times the number of cases as Staten Island.The reasons for these disparities have been discussed at length and include rates of preexisting comorbidities, a majority of the population employed in essential bluecollar jobs, living conditions, health literacy, and access to health care. 2 The impact of these changes on already wellestablished cancer care disparities is unknown but potentially devastating.At this time, oncologists have had to make difficult decisions weighing the benefits of treatment against the risks of COVID-19 infection and the increased risk of death among patients with cancer.Surgeries have been postponed, and chemotherapy and radiotherapy regimens have been delayed or altered to expedite treatment and minimize risk of exposure to coronavirus.It remains unclear the extent to which active or prior cancer diagnosis influences one's risk of COVID-19 infection.In a study of 1099 Chinese patients, cancer patients comprised 1% of COVID-19 cases.However, in initial reports from New York City, patients with cancer represent 6% of COVID-19 cases and 8% to 9% of those deemed critically ill or requiring mechanical ventilation.Moreover, patients with non-small cell lung cancer comprised more than half of COVID-19 cancer cases, suggesting differing susceptibilities based on the primary disease. 3ationwide, the breast cancer mortality rate is 40% higher for Black patients compared with White patients.In New York City, this inequity has worsened over time, increasing from 19% to 27% between 2005 to 2014.Similarly, the cervical cancer mortality rate is 23% higher for Hispanic women and 71% higher for Black women as well as for those residing in poorer neighbor-

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