Black men with prostate cancer were much more likely to lose crucial treatment during the COVID-19 pandemic compared to white men, a new study suggests.
In the early months of the crisis, only one percent of black men with prostate cancer had the organ removed, compared with 26 percent of white patients, researchers at Fox Chase Cancer Center in Philadelphia found.
The two groups had similar COVID-19 risk factors and rates of biological signals that indicate a greater chance of serious cancer.
In addition, before the pandemic, black and white patients underwent prostate removal surgery at similar rates.
These findings provide new evidence for how health inequalities worsened during the pandemic, the researchers say.
Now, health care providers must respond by helping black men and other vulnerable patients catch up on their care.
During COVID-19 lockdowns, black men with prostate cancer were less likely to have critical surgery compared to white men (file image)
When cancer clinics delayed or canceled prostate removal surgery, black patients were more likely to miss treatment than white patients
Numerous studies have shown that when the pandemic caused lockdowns in the spring of 2020, other forms of health care were suspended.
Hospitals across the country focused on addressing the needs of COVID-19 patients. Other non-emergency treatments and doctor’s appointments were postponed – or canceled altogether.
While this shift helped the health care system manage the Covid crisis, doctors worried that a drop in other types of appointments would increase health inequalities for already vulnerable populations.
Black, Hispanic and other minorities in the US have had worse Covid outcomes, in part because they are already more vulnerable to other chronic conditions.
But during the pandemic, these groups have also faced more barriers to healthcare. For example, hospitals in urban centers are more likely to become overwhelmed.
The new study, published on Thursday in JAMA Oncology, shows that the pandemic has in fact widened disparities in prostate cancer treatment.
Prostate cancer affects one in seven black men in the US, the researchers wrote.
Black patients are also more likely to be diagnosed with advanced prostate cancer — and more likely to die from the disease — compared to white patients.
But if treatment is equitable, previous studies have shown, it can improve these gaps in mortality, suggesting that care differences are to blame and not underlying biological differences.
The research group used anonymous patient data from the Pennsylvania Urologic Regional Collaborative, a group of 11 cancer practices in Pennsylvania and New Jersey.
They looked at treatment differences between black and white prostate cancer treatments, with an emphasis on prostatectomies.
A prostatectomy, or the removal of a patient’s prostate, is a common treatment for patients with a less severe diagnosis.
The study included approximately 270 patients treated in the clinics between March and May 2020, and 380 patients treated between March and May 2019. The 2020 period coincided with lockdowns in Pennsylvania.
Black patients were much less likely to have their prostates removed during the pandemic compared to white patients, the researchers found.
Of the 76 black patients treated during the Covid lockdown, only one underwent this procedure — just one percent.
In contrast, among white patients, 50 of 193, or 26 percent, underwent the procedure.
This difference occurred even though the two groups had similar risk factors for Covid and other conditions. The groups also had similar percentages of biological signals indicating a higher risk of serious prostate cancer.
In fact, the black patients were younger on average — which should have given them a higher priority for surgery, the researchers said.
Of the 76 black patients treated by the study sites during the Covid lockdown, only one underwent surgery
Of the patients treated in 2019, black and white patients had similar surgery rates. In this group, 18 percent of black patients and 19 percent of white patients had surgery removed.
When the lockdown hit, black men experienced a 91 percent lower rate of prostatectomy — while white men were just 17 percent lower.
After the lockdown ended in May 2020, the researchers found that rates between the two groups were leveling again.
Clinics that had the greatest reduction in cancer surgeries also tended to serve black populations, the researchers found.
In the two most affected sites, 41 percent of patients were black.
Meanwhile, 82 percent of patients at the sites that didn’t have to close as intensively were white.
This is in line with comparable findings from other hospitals. The researchers cite a New York City study that found that a hospital in Queens had to stop treatments for breast cancer completely, while a hospital in Manhattan was able to continue treatments at reduced capacity.
“Lessons from this study suggest systemic inequalities in health care and are likely applicable across all medical specialties,” the researchers wrote in their paper.
The researchers said cancer clinics must now respond to the inequalities patients faced during the pandemic.
That means prioritizing black patients and others from vulnerable communities whose treatments have been delayed in 2020.