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Disclosures: All authors report employment with and stock ownership in Quest Diagnostics.
October 01, 2020
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Sharp declines in new cancer diagnoses observed during COVID-19 pandemic

Source/Disclosures
Disclosures: All authors report employment with and stock ownership in Quest Diagnostics.
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The number of newly identified patients with six common types of cancer declined significantly.

The drop began soon after the COVID-19 pandemic began, according to data in a research letter published in JAMA Network Open.

The number of newly identified patients with six common types of cancer declined significantly soon after the COVID-19 pandemic began.
The number of newly identified patients with six common types of cancer declined significantly soon after the COVID-19 pandemic began.

The findings mirror those of other countries, researchers noted.

“[Although] residents have taken to social distancing, cancer does not pause,” Harvey W. Kaufman, MD, senior medical director at Quest Diagnostics, and colleagues wrote. “The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.”

At the start of the COVID-19 pandemic, ASCO recommended cancer screening procedures that require visits to clinics or centers be postponed in order to conserve resources and reduce patient contact with health care facilities.

Kaufman and colleagues conducted a cross-sectional study to evaluate weekly changes in the number of patients with newly identified cancer before and during the pandemic.

The study included 258,598 patients during the baseline period (Jan. 6, 2019-Feb. 29, 2020) and 20,180 patients during the COVID-19 period (March 1-April 18, 2020) who received testing for any cause by Quest Diagnostics and whose ordering physicians diagnosed them with one of six common cancer types, including breast, colorectal, lung, pancreatic, gastric and esophageal.

Researchers counted each patient once and tracked them from the first full calendar week of 2019 until April 18, 2020.

They compared mean weekly numbers of newly diagnosed patients, along with mean ages and sex distributions, between the baseline period and the COVID-19 period.

Mean age of all patients was 66.1 years, and 75.1% were women.

Results showed that, during the pandemic, the mean weekly number of newly identified patients fell by 46.4% for the six cancers combined, from 4,310 during the baseline period to 2,310.

Significant declines occurred among all cancer types. These ranged from 24.7% for pancreatic cancer (P = .01) to 51.8% for breast cancer (P < .001), according to the research letter.

Mean age of patients with cancer during the COVID-19 period was within 1 year of patients with cancer during the baseline period.

Although patients diagnosed with esophageal cancer in the COVID-19 period were slightly older than those diagnosed during baseline (mean age, 69.5 years vs. 68.4 years; P = .04), patients with all other cancers were younger during the COVID-19 period.

Sex distribution appeared to be the same for all cancers except pancreatic, which had fewer women in the baseline group than the COVID-19 group (49.8% vs. 53%; P = .01). The decrease leveled off beginning the week of March 29, 2020.

Researchers acknowledged that the association of delayed cancer diagnoses with outcomes probably depends on the final stage of disease relative to baseline, as well as related treatment implications, which could serve as a limitation to the study.

“Our findings are consistent with previous research and they call for urgent planning to address the consequences of delayed diagnoses,” Kaufman and colleagues wrote. “Planning may entail more robust digital technology to strengthen clinical telehealth offerings and other patient-clinician interactions, including self-service scheduling across specialties and well-designed collection processes.”