Masking Policies at National Cancer Institute–Designated Cancer Centers During Winter 2023 to 2024 COVID-19 Surge

This cross-sectional study examines variation in masking policies at National Cancer Institute (NCI)–designated cancer centers during the winter 2023-2024 COVID-19 surge.


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. 3,4We 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 quality 5 : 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. 4Two 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 χ 2 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 < .05indicated 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

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JAMA Network
No, provided but outdated Yes, up-to-date 14 (20.9)

Inconsistencies between cancer center website and telephone information
Stronger precautions indicated by telephone vs website 4 (6.0) Weaker precautions indicated by telephone vs website 4 (6.0) a Telephone information was used when there were discrepancies in precaution policies from the website.Website data were collected on January 15, 2024, and telephone data were collected within 72 hours of this date.All data were collected shortly after the midpoint of the surge on January 9, 2024.c When a cancer center had more than 1 affiliated clinic in the rankings, the higher of the rankings was used.Bottom quintiles were combined because none of the institutions were ranked in the top 50 of the US News & World Report.

Table 2 .
Proportion of National Cancer Institute-Designated Cancer Centers With Universal Masking Precautions b NIH RePORTER funding records covered 1985 through February 2024.