Disparities in Cancer Outcomes from the COVID-19 Pandemic

项目摘要 背景：2020年3月，在全国范围内暂停所有择期临床服务，以减缓 预防COVID-19的传播，保护患者并保护医疗资源。这导致了一个主要的 干扰癌症筛查和诊断程序。在全国的退伍军人中，我们发现了一个重要的 以及新癌症检测率的持续下降。如果没有常规的筛查和容易获得的 在医疗护理方面，癌症患者可能无法被发现，只有当癌症无法治愈时才出现。 与COVID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 在弱势群体中取得的成果。 重要性：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，卫生系统无法识别处于风险中的人群，也无法实施减轻风险的计划。 目前的赤字。我们需要全面评估大流行对癌症护理的破坏 影响癌症的预后此外，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，随着大流行病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）癌症复发率和3） 出现转移性疾病。此外，上述结果的差异将在2010年加剧。 以下脆弱亚组患者的COVID时代：女性，年龄> 60岁，黑人，拉丁美洲人，农村， 或者在社会经济地位较低的地区。我们将通过以下具体目标来评估这些假设：1） 按癌症类型确定COVID和前COVID时代之间癌症结局的差异。2)识别 在COVID时代，弱势群体之间的癌症结果差异。 方法：使用来自退伍军人管理局信息学和 计算基础设施（芬奇），我们将评估从COVID前（3月1日， 2018年至2020年2月29日）至COVID（2020年3月1日至2025年2月28日）时代。泊松和考克斯 比例风险模型将用于分析癌症从COVID前到COVID时代的变化 类型和弱势群体之间。 后续步骤/实施：芬奇数据集提供了一个独特的机会， 评估新癌症识别持续中断对癌症结局的影响， 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可操作的数据 以及一个监督系统，以指导解决已查明的差距的干预措施。使用经验证的 在本项目中开发的系统，我们将扩展到VA以外的人群，并启动介入治疗 开展研究，以减轻或消除已查明的差距。

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.