key: cord-0842789-1giw1cm5
authors: Doroshow, D.; Schmidt, A. L.; Bakouny, Z.; Bhalla, S.; Steinharter, J. A.; Tremblay, D.; Awad, M. M.; Kessler, A. J.; Bouchard, G.; Evans, M.; Busser, F.; Zimmerman, B. S.; Curran, C. R.; Jun, T.; Haddad, R.; Qin, Q.; Nuzzo, P. V.; Feld, J.; Galsky, M. D.; Choueiri, T. K.
title: Disparities in cancer during the COVID-19 pandemic: COVID-19 and cancer outcomes study (CCOS)
date: 2020-09-30
journal: Annals of Oncology
DOI: 10.1016/j.annonc.2020.08.2315
sha: 28db863557a04b4879391c2e51a687a79c8f5643
doc_id: 842789
cord_uid: 1giw1cm5

nan

highly dysfunctional. In addition the SARS-CoV-2 specific CD8 T cell responses displayed an increased expression of NKG2A in comparison with bulk CD8 T cells, which may explain their dysfunctional state.

Conclusions: Our data suggest that part of the ORF1ab encodes multiple CD8 T cell antigens including one immunodominant epitope. Noteworthy these epitopes were derived from a part of the viral genome that is not included in the majority of vaccine candidates in development, and this may potentially influence their clinical activity and safety profile.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding. Methods: CCOS is a multicenter prospective cohort study designed to define the impact of the pandemic on cancer care delivery and outcomes. The CCOS cohort comprised consecutive outpatients with cancer seen at two US cancer centers from March 2 to March 6, 2020 (index visit). Data was collected at baseline, retrospectively from the preceding 3 months, and prospectively at 3-month follow up. Per patient changes in numbers of visits were compared using Wilcoxon signed rank tests. Correlates of increases in telehealth visits and decreases in in-person visits were evaluated using multivariable logistic regression models. Adjusted Odds ratios [aOR] and 95% confidence intervals (CI) were reported.

Results: Of 2365 included patients, 1219 (51.6%) had a decrease in in-person visit frequency during the pandemic period relative to the preceding 3 months. Conversely, 760 (32.2%) had an increased frequency of telehealth visits (decrease in in-person and increase in telehealth visits; both p<0.01). 128 (5.4%) patients developed COVID-19. Compared to White patients, Black and Hispanic patients were less likely to have telehealth visits, had no significant change in frequency of in-person visits, and were more likely to develop COVID-19 (Table) .

Conclusions: Significant disruptions to routine cancer care were observed during the pandemic period relative to the prior 3 months. Racial and ethnic barriers to the adoption of telehealth, and related socioeconomic factors, place these vulnerable populations simultaneously at disproportionate risk for decreased cancer-related visits and COVID infection, thereby exacerbating existing racial and ethnic health disparities.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding. 

Department of Medicine, Division of Medical Oncology, Mount Sinai Pediatric Associates Practice

Cliniche Humanitas Gavazzeni

N (%); aOR (95% CI)* Increase in telehealth visits Decrease in in-person visits COVID-19 diagnosis

0%) 1.86 (1.10 e 3.11) Hispanic 65

Adjusted for cancer disease group, cancer center, cancer status, and receipt of systemic therapy (during index week)