Post by Nadica (She/Her) on Aug 2, 2024 2:35:53 GMT
Masking Policies at National Cancer Institute–Designated Cancer Centers During Winter 2023 to 2024 COVID-19 Surge - Published July 31, 2024
Introduction
Although people with cancer have above-average risk of COVID-19 vaccine antibody nonresponse, breakthrough infections, hospitalizations, long COVID, infection-associated treatment delays, and mortality,1,2 health care masking policies remain contentious. Surveillance data suggest the winter 2023 to 2024 surge had the second highest peak of COVID-19 transmission in the US.3,4 We assessed masking policies at National Cancer Institute (NCI)–designated cancer centers near the midpoint of the winter 2023 to 2024 US COVID-19 surge and examined variation by region and proxy indicators of quality5: NCI designation duration, funding, and care rankings.
Methods
In this cross-sectional study, we reviewed the websites of all NCI-designated clinical cancer centers to analyze COVID-19 policies on January 15, 2024. This date was selected based on forecasting models suggesting the date to be near the surge’s midpoint, estimated in hindsight to be January 9, 2024.4 Two raters (including D.R., B.M., B.S., T.P., T.M.A.) identified whether any universal masking requirements (eg, all staff and visitors must mask in designated areas) existed. Raters also recorded the locations with requirements, whether any nonuniversal masking requirements (eg, mask if symptomatic) existed, and whether the websites indicated or linked directly to current COVID-19 policies. At least 1 rater called each center within 72 hours to verify policies and, in rare situations of uncertainty or inconsistency, asked to speak to an individual who could provide definitive policy information. In accordance with the Common Rule, this study was exempt from ethics review and informed consent requirement because it was not considered human participant research. We followed the STROBE reporting guideline.
Frequencies and percentages summarized the descriptive statistics. Exploratory analyses used χ2 and Kendall tau to examine whether Census region (Northeast, Midwest, South, West), ongoing NCI designation duration (quintiles), cumulative NCI-designated program funding (P30 grants) (quintiles), and US News & World Report oncology care rankings (quintiles) were associated with having a universal masking policy in at least some designated areas (yes or no).
Two-sided P < .05 indicated statistical significance. Analyses were conducted in SPSS 28.0.1.1 (IBM).
Results
COVID-19 policies were confirmed at all 67 patient-serving NCI-designated cancer centers. As shown in Table 1, 28 cancer centers (41.8%) required universal masking in at least some clinical areas, with 12 (17.9%) requiring universal masking in all areas. Only 14 (20.9%) had accurate up-to-date policies flagged on the home page of their websites. In 8 cancer centers (12.0%), policies posted on websites differed from those noted by telephone. Cancer centers were more likely to require universal masking in at least some areas if they were located in the Northeast (11 [78.6%]), had longer NCI designation duration (first quintile: 10 [83.3%]), had more program funding (first quintile: 11 [84.6%]), or had a higher care ranking (first quintile: 11 [84.6%]) (Table 2).
Discussion
Highlighting clinical equipoise, 41.8% of NCI-designated cancer centers required universal masking in at least some clinical areas during the winter 2023 to 2024 COVID-19 surge. Such policies were more common in the Northeast, despite higher transmission in the South and Midwest.3 Longer NCI designation, more program funding, and higher care rankings were also associated with having universal masking policies. With 8 waves of elevated COVID-19 transmission,3,4 health care system–acquired COVID-19 infections are highly preventable, with debates surrounding prevention pros and cons.6 Cancer centers with masking policies should delineate the data and decision-making models underlying their policy to inform other centers considering their own policies.
Study limitations include a focus on a time point in the COVID-19 pandemic, in the US, and at academic cancer centers with NCI designation; thus, findings may have limited generalizability to other contexts. More research funding and studies are needed to examine the implications of mitigation policies for infection rates among patients and medical personnel, treatment discontinuities, hospitalizations, long COVID, and mortality. Although contentious, universal masking precautions were common at NCI-designated cancer centers during the winter 2023 to 2024 surge, especially at more established, better-funded, and higher-ranked centers.
Article Information
Accepted for Publication: June 3, 2024.
Published: July 31, 2024. doi:10.1001/jamanetworkopen.2024.24999
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Hoerger M et al. JAMA Network Open.
Introduction
Although people with cancer have above-average risk of COVID-19 vaccine antibody nonresponse, breakthrough infections, hospitalizations, long COVID, infection-associated treatment delays, and mortality,1,2 health care masking policies remain contentious. Surveillance data suggest the winter 2023 to 2024 surge had the second highest peak of COVID-19 transmission in the US.3,4 We assessed masking policies at National Cancer Institute (NCI)–designated cancer centers near the midpoint of the winter 2023 to 2024 US COVID-19 surge and examined variation by region and proxy indicators of quality5: NCI designation duration, funding, and care rankings.
Methods
In this cross-sectional study, we reviewed the websites of all NCI-designated clinical cancer centers to analyze COVID-19 policies on January 15, 2024. This date was selected based on forecasting models suggesting the date to be near the surge’s midpoint, estimated in hindsight to be January 9, 2024.4 Two raters (including D.R., B.M., B.S., T.P., T.M.A.) identified whether any universal masking requirements (eg, all staff and visitors must mask in designated areas) existed. Raters also recorded the locations with requirements, whether any nonuniversal masking requirements (eg, mask if symptomatic) existed, and whether the websites indicated or linked directly to current COVID-19 policies. At least 1 rater called each center within 72 hours to verify policies and, in rare situations of uncertainty or inconsistency, asked to speak to an individual who could provide definitive policy information. In accordance with the Common Rule, this study was exempt from ethics review and informed consent requirement because it was not considered human participant research. We followed the STROBE reporting guideline.
Frequencies and percentages summarized the descriptive statistics. Exploratory analyses used χ2 and Kendall tau to examine whether Census region (Northeast, Midwest, South, West), ongoing NCI designation duration (quintiles), cumulative NCI-designated program funding (P30 grants) (quintiles), and US News & World Report oncology care rankings (quintiles) were associated with having a universal masking policy in at least some designated areas (yes or no).
Two-sided P < .05 indicated statistical significance. Analyses were conducted in SPSS 28.0.1.1 (IBM).
Results
COVID-19 policies were confirmed at all 67 patient-serving NCI-designated cancer centers. As shown in Table 1, 28 cancer centers (41.8%) required universal masking in at least some clinical areas, with 12 (17.9%) requiring universal masking in all areas. Only 14 (20.9%) had accurate up-to-date policies flagged on the home page of their websites. In 8 cancer centers (12.0%), policies posted on websites differed from those noted by telephone. Cancer centers were more likely to require universal masking in at least some areas if they were located in the Northeast (11 [78.6%]), had longer NCI designation duration (first quintile: 10 [83.3%]), had more program funding (first quintile: 11 [84.6%]), or had a higher care ranking (first quintile: 11 [84.6%]) (Table 2).
Discussion
Highlighting clinical equipoise, 41.8% of NCI-designated cancer centers required universal masking in at least some clinical areas during the winter 2023 to 2024 COVID-19 surge. Such policies were more common in the Northeast, despite higher transmission in the South and Midwest.3 Longer NCI designation, more program funding, and higher care rankings were also associated with having universal masking policies. With 8 waves of elevated COVID-19 transmission,3,4 health care system–acquired COVID-19 infections are highly preventable, with debates surrounding prevention pros and cons.6 Cancer centers with masking policies should delineate the data and decision-making models underlying their policy to inform other centers considering their own policies.
Study limitations include a focus on a time point in the COVID-19 pandemic, in the US, and at academic cancer centers with NCI designation; thus, findings may have limited generalizability to other contexts. More research funding and studies are needed to examine the implications of mitigation policies for infection rates among patients and medical personnel, treatment discontinuities, hospitalizations, long COVID, and mortality. Although contentious, universal masking precautions were common at NCI-designated cancer centers during the winter 2023 to 2024 surge, especially at more established, better-funded, and higher-ranked centers.
Article Information
Accepted for Publication: June 3, 2024.
Published: July 31, 2024. doi:10.1001/jamanetworkopen.2024.24999
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Hoerger M et al. JAMA Network Open.