Disparities in Cancer Outcomes from the COVID-19 Pandemic

项目总结 背景：2020年3月，全国范围内暂停了所有选择性临床服务，以减缓 传递新冠肺炎，保护患者，节约医疗资源。这导致了一场重大的 扰乱癌症筛查和诊断程序。在全国退伍军人中，我们发现了一个显著的 以及新癌症的检测率持续下降。不需要常规筛查，也不容易获得 在医疗方面，癌症患者可能不会被发现，只有在癌症无法根治的时候才会出现。 与COVID相关的史无前例的中断也可能加剧了先前存在的癌症差异 在弱势群体中取得的成果。 重要意义：没有关于新冠肺炎大流行对癌症结果或变化影响的信息 在结果差异方面，卫生系统无法识别处于危险中的人群，也无法实施缓解方案 当前的赤字。我们需要全面评估大流行对癌症护理造成的干扰 影响癌症的结局。此外，我们还需要一个监测系统来评估癌症预后的变化。 随着时间的推移，随着大流行影响的演变和缓解努力的实施。我们假设 COVID时代的癌症结局将恶化，1)死亡率，2)癌症复发，3) 出现转移性疾病。此外，上述结果之间的差距将在 在以下易患亚组患者中感染新冠状病毒：女性，年龄和年龄；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来评估这些假设：1) 根据癌症类型确定COVID和前COVID时代癌症预后的差异。2)识别 在COVID时代，弱势人群中癌症结局的差异。 方法：使用退伍军人管理局信息学和退伍军人管理局提供的详细的、全国性的患者水平数据 计算基础设施(Vinci)，我们将评估与COVID前相比癌症预后的变化(3月1日， 2018年至2020年2月29日)到COVID(2020年3月1日至2025年2月28日)时代。泊松和考克斯 比例风险模型将被用来分析癌症从前COVID时代到COVID时代的变化 类型和在易受伤害的亚群中。 后续步骤/实施：Vinci数据集提供了一个独特的机会，可提供近乎实时的 评估新癌症鉴定的持续中断对癌症结局的影响以及 加剧了医疗保健危机中现有的差距。这个项目将使我们能够开发出可操作的数据 以及一个监测系统，以指导解决已查明的差异的干预措施。使用经过验证的 在这个项目中开发的系统，我们将扩展到退伍军人管理局以外的人群，并启动干预 旨在缓解或消除已确定的差距的研究。

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.