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Disparities in Surgical Oncologic Care

E125: Impact of COVID-19-pandemic on surgical cancer care disparities by socioeconomic status

Introduction: An increasing emphasis is placed on the disproportionate effects of cancer on people of lower socioeconomic status on all aspects of cancer care. Although surgical cancer treatments were prioritised in the Netherlands during the COVID-19-pandemic, healthcare scarcity may have exacerbated pre-existing disparities. This study aims to investigate this impact in the Dutch population.

Methods: This population-based cohort study included all patients undergoing surgery for lung-, oesophageal-, gastric- and pancreatic cancer, and malignant liver tumours registered at the Dutch Institute for Clinical Auditing. Data from the pandemic cohort (15-03-2020 to 31-12-2021) were compared to a historic cohort (2018-2019). Socioeconomic status (SES) scores of individual patients were based on average SES by postal code and divided into five categories. Multiple imputation by chained equation was performed. The primary outcome was the difference in distribution of SES between the pandemic and historic cohorts; assessed with a density plot and chi-squared test on SES categories. Secondary outcomes were time to treatment and tumour stage distribution. Multivariate logistic regression was performed, taking into account all variables associated with tumour stage.

Results: A total of 28,109 procedures were analysed; 12,229 in the pandemic group and 15,810 in the historic group. The mean number of procedures per week decreased from 139 in the historic group to 131 procedures in the pandemic group (- 6%, p < 0.001) The median SES score was 0.058 in both groups, with an interquartile range between -0.120 and 0.186 in the historic group and between -0.122 and 0.187 in the pandemic group. Furthermore, the distribution of SES-categories and the density heatmap (figure 1) did not show any differences between the pandemic and historic groups. The median time between diagnosis and treatment decreased from 23 days in the historic group to 22 in the pandemic group (p 0.05) and was comparable amongst SES-categories. Neither were patients of lower socioeconomic status more likely to be operated for a stage 4 malignancy. When corrected for age, sex, comorbidities and BMI, SES was not correlated to tumour stage in the pandemic group (OR 0.91, CI 0.82 – 1.02, p 0.10), nor in the historic group (OR 1.04, CI 0.94 – 1.15, p 0.5). A sub-analysis for elderly patients ( >70 years) showed a similar impact.

Conclusions:

On the population level, healthcare scarcity during the COVID-19-pandemic seems to have had an equal impact on surgical cancer care for patients of varying socioeconomic status in the Netherlands; possibly due to prioritising cancer care.

Learning Objectives:

  • appraise the impact of the COVID-19-pandemic on healthcare disparities
  • explore different measures of access to surgical cancer care
  • discuss the differences of healthcare disparities in different countries