Impact of the COVID-19 Pandemic on the Utilization of Stereotactic Radiosurgery among Racial Minorities Diagnosed with Brain Metastases

Introduction: Brain metastases (BM) is the most common form of adult brain tumors. Stereotactic radiosurgery (SRS) is an established and effective treatment for patients with oligometastatic BM. We examined how the COVID-19 pandemic impacted clinical utilization of SRS in BM treatment and generalize such impact to outpatient care for all cancer types.

Methods: Three national-scale datasets were used: National Cancer Database (NCDB, N=5238), the National COVID Cohort Collaborative database (N3C, N=13106 for BM, N=203706 for all cancer types), and Surveillance Epidemiology and End Results (SEER). Multivariable logistic regression models were performed to determine whether the pandemic affected clinical utilization of SRS in BM treatment and chemotherapy initiation for all cancer types.

Results: Prior to 2019, we observed no racial disparity in the odds of receiving SRS between non-Hispanic white (NHWs) and non-Hispanic black (NHBs) BM patients in NCDB and N3C. Between 2020 and 2021, however, NHB BM patients were significantly less likely to receive SRS comparing to NHWs in both NCDB (NHB: aOR-0.77, p=0.002) and N3C (NHB: aOR-0.78, p< 0.001). In SEER, the age-adjusted incidence rate of BM remained unchanged when comparing pre- and post-pandemic periods. Further substantiating the impact of the COVID pandemic on racial disparity in outpatient care for all cancer patients, we showed that NHB patients were significantly more likely to receive delayed chemotherapy (>60 days after diagnosis) comparing to NHWs during the pandemic (aOR-1.10, p< 0.001), but such association was not detected before pandemic. Ratio of odds ratio analysis confirmed that NHB patients comparing to NHWs during pandemic experienced 1.11-fold difference in the odds of delayed chemotherapy between NHBs and NHWs before pandemic [ROR=1.11, p< 0.001].

Conclusion : Our study suggests that racial disparity in the receipt of SRS for BM patients has been exacerbated during the COVID-19 pandemic and such impact could be generalized to outpatient care for all cancer types. Understanding the determinants giving rise to this disparity should augment the readiness of our cancer care infrastructure in anticipation of future pandemics or other public health crises.