Care Coordination for Complex Cancer Survivors in an Integrated Safety-Net System

项目总结/文摘

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic presents a new and significant health threat for cancer survivors. Cancer survivors are often immuno-compromised from cancer treatment and thus may have higher risks of contracting COVID- 19 in addition to adverse outcomes related to cancer. Early findings among COVID patients show that individuals with a history of cancer have a higher risk of severe events that resulted in admittance to the intensive care unit, ventilation support, or premature death. COVID-19 also disproportionately affects vulnerable, underserved, and ethnic minority populations; many of these receive their health care at safety-net health systems such as Parkland. Those who are African American and Latino or who are uninsured are also more likely to have underlying medical conditions such as diabetes, heart conditions, asthma, severe obesity, liver disease. In addition to increased risk of COVID-19 infection, cancer patients may also be experiencing disruptions and changes to their clinical care routines due to COVID-19 shutdown and work-from-home orders; survivors may experience delays in cancer treatment and follow-up care. Thus, racial/ethnic minority and underserved cancer survivors who also have co-occurring chronic conditions represent the "perfect storm" of risk factors for significant impacts on health outcomes as well as increasing health disparities. With this supplement, we will examine the impact of COVID-19 on care for vulnerable cancer survivors with high clinical risk further exacerbated by multiple chronic conditions, who are predominantly racial/ethnic minorities, uninsured, and served by a safety-net health system. Our specific aims are: Aim 1: Assess the impact of COVID-19 on the overall health and wellbeing of cancer survivors. Using a mixed-methods approach (patient surveys and semi-structured interviews), we will assess the COVID-19 effect on patients' physical, emotional, and mental health, financial impact, and coping. Aim 2: Assess the impact of COVID-19 on cancer survivors' access to cancer and non-cancer treatment and healthcare utilization. We will capture how the pandemic impacted the delivery of cancer care and other healthcare services in this integrated safety-net system. We will examine whether there were treatment delays related to cancer or other co-morbidities, challenges accessing care during this time, and the quality of care delivered. Additionally, we will document and quantify the nature of COVID-19 encounters among our cohort of complex cancer survivors, using electronic health record (EHR) data extraction and analysis. These aims directly leverage existing research methods from the parent R01, adding new covariates and patient-reported data specific to the COVID-19 experience. Given that COVID-19 has changed the care delivery process and there is an expectation of other cycles of the disease, our findings will guide stakeholders in the development of new and alternative care strategies that may mitigate impact among vulnerable, complex cancer survivors.