Cancer-related patient encounters, screenings drop sharply amid COVID-19 pandemic
Cancer-related patient encounters have decreased significantly as a result of the COVID-19 pandemic, according to trends observed in the COVID and Cancer Research Network and reported in JCO: Clinical Cancer Informatics.
The largest decline occurred in encounters linked to new cancer incidence, including screening, initial diagnosis, second opinion and appointments to initiate treatment. This could lead to future increases in patients diagnosed with later-stage disease and greater demand for cancer screening procedures because of rescheduled tests, researchers noted.
“[Although] it is not surprising that the pandemic has had a significant impact on patients seeking care, it was important to test and quantify these trends using a large, institutionally agnostic data set, as the results have important implications for future [patients with cancer] and the potential burden on hospitals moving forward,” Christopher McNair, PhD, director of cancer informatics at Sidney Kimmel Cancer Center – Jefferson Health, said in a press release. “The decreases themselves were not unexpected; [however], the magnitude of decline, while using a national cohort this large, was surprising.”
Studies are being conducted to characterize the direct effects of the COVID-19 pandemic on cancer care, but few reports have quantified the impact of decisions being made to control the pandemic on the normal course of cancer diagnosis and treatment encounters.
McNair and colleagues used the TriNetX platform to analyze 20 U.S. health care institutions, representing more than 28 million patients, with relevant, up-to-date encounter data. They compared the number of cancer-related encounters among patients in this TriNetX subset, called the COVID and Cancer Research Network, during the period before (January 2019-April 2019) and during (January 2020-April 2020) the pandemic.
Study groups included all patients with neoplasms (malignant, benign, in situ and of unspecified behavior), those with new incidence neoplasms (first encounter), those with exclusively malignant neoplasms and those with new incidence malignant neoplasms.
Researchers also analyzed data from an institution in the U.K. and conducted separate analyses of patients with specific cancers and those who underwent cancer screening.
Results showed clear trends that suggested a significant decline in encounters among all groups, with the largest decreases occurring in April. These included declines in patients with encounters linked to any neoplasm (56.9%), new incidence neoplasms (74%), malignant neoplasms (50%) and new incidence malignant neoplasms (65.2%). The U.K. data showed similar trends.
Among all cancer types analyzed, lung, colorectal and hematologic cancer groups exhibited declines of about 39% in April 2020 compared with April 2019. Researchers observed larger decreases in encounters for breast cancer (47.7%), prostate cancer (49.1%) and melanoma (51.8%).
Cancer screenings declined sharply, particularly for breast cancer (89.2%) and colorectal cancer (84.5%).
“The most significant finding in our study was the considerable drop in cancer screenings,” McNair said. “The fact that this trend was so drastic nationwide is telling of the widespread effect of the pandemic and mitigation efforts — even in regions that had not seen a significant impact from the virus at the time.”