Assessing for disparities in access to gynecologic oncology care during the COVID-19 pandemic at a single institution (453)

Objectives: To evaluate disparities in access to gynecologic oncology care among newly referred patients at a tertiary care center before and during the COVID-19 pandemic. Methods: All new referrals to gynecologic oncology at a tertiary care center between November 1, 2018, and July 31, 2021, were reviewed for demographic characteristics, including age at the time of referral, race, and distance traveled. Patients were categorized into two groups: those seeking care before the start of the COVID-19 pandemic (“Pre-COVID,” November 2018 through February 2020) and after (“COVID,” March 2020 through July 2021). Distance traveled was approximated by straight-line distance from patient zip code to hospital zip code. Patients were categorized by distance traveled: <10 miles, 10-25 miles, and >25 miles. A two-tailed Student’s t-test was used to assess differences in distance traveled between the Pre-COVID and COVID groups. A sub-analysis was conducted to evaluate for differences by race. Results: A total of 1,954 new patient visits were recorded during the selected timeframe; 928 new patients were seen before, and 1,027 were during the pandemic. The mean age for both groups was 55 years. The mean distance traveled was 30 miles and 27 miles, respectively. The distribution of patients between the three distance categories was comparable. Pre-COVID, 33.4% of patients traveled <10 miles, 35.9% of patients traveled 10-25 miles, and 30.7% of patients traveled >25 miles. During COVID, the distribution was 35.6%, 35.2%, and 29.1%, respectively. There was no significant difference found in the distance traveled among patients seeking care before and during the pandemic (p=0.205). In the Pre-COVID group, 56.8% of new patients were White, and 37.3% were Black. In the COVID group, 52.5% were White, and 41.5% were Black. Subgroup analysis showed no difference in distance traveled by race (for Blacks, p=0.0903; for Whites, p=0.843). Conclusions: The COVID-19 pandemic created an enormous burden on the healthcare system. There is growing concern that patients are less likely to seek care during the pandemic, leading to missed or delayed diagnoses. This study showed that despite a global pandemic, patients still traveled comparable distances to be seen by a gynecologic oncologist. Similarly, no racial discrepancies were found between new patients seen during this time period. This suggests that patients continue seeking care despite the impact of COVID-19. Given our large catchment area and diverse population, mechanisms are already in place to facilitate access for our patients minimizing delay in their evaluation and treatment.