Nationwide Decrease Seen in Cancer-Related Encounters Due to the COVID-19 Pandemic

Karen E. Knudsen, MBA, PhD

Research published in JCO Clinical Cancer Informatics indicated that there has been a significant nationwide decrease in all cancer-related patient encounters as a result of the coronavirus disease 2019 (COVID-19) pandemic.¹

The findings also inherently suggest the possibility of a future increase in patients with later-stage cancer being seen, as well as an increased demand for cancer screening procedures due to delayed tests being rescheduled.

“These findings are truly striking, as modeling from the National Cancer Institute has predicted thousands of expected increases in cancer death as a result of deferred breast and colorectal screening alone,” Karen E. Knudsen, MBA, PhD, executive vice president of Oncology Services at Jefferson Health and enterprise director of the Sidney Kimmel Cancer Center (SKCC), said in a press release.² “This report is a nationwide call to arms, underscoring the urgent need to resume cancer screening and early detection.”

Using the TriNetX platform, researchers analyzed 20 different healthcare institutions with relevant, up-to-date encounter data from January 1, 2019 through April 30, 2020 to create the COVID and Cancer Research Network (CCRN). They then compared the data from cohorts of patients with cancer pre-COVID (January 2019 to April 2019) to current cohorts (January 2020 to April 2020). Notably, cohorts were generated for all patients with neoplasms (malignant, benign, in situ, and of unspecified behavior), with new incidence neoplasms (first encounter), with exclusively malignant neoplasms, and with new incidence malignant neoplasms.

Overall, unambiguous trends were identified which suggested a significant decline in all current cohorts evaluated, with April 2020 displaying the largest decrease in the number of patients with cancer having encounters. More specifically, among the cancer types identified, the lung, colorectal, and hematologic cancer cohorts demonstrated smaller decreases in size in April 2020 versus 2019 (-39.1%, -39.9%, -39.1%, respectively) compared with cohort size decreases for breast cancer, prostate cancer, and melanoma (-47.7%, -49.1%, -51.8%, respectively).

In addition, the investigators also found that mammograms declined 89.2% in April 2020 compared with April 2019, and colorectal cancer screenings declined by 84.5% during the same period. Moving forward, the researchers indicated that they intend to track screenings in the coming months as virus mitigation efforts are eased to help predict how many patients are continuing to delay cancer screenings due to the pandemic.

“The most significant finding in our study was the considerable drop in cancer screenings. 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,” senior author Christopher McNair, PhD, director of Cancer Informatics at SKCC, said in the release.

Throughout the summer and into the fall, the researchers will continue to observe the trends in care of patients with cancer, especially as more states become more drastically affected. According to McNair, it will be important to understand trends in cancer diagnoses to determine if delays in screening are resulting in an increased number of patients presenting with later-stage disease.

“Ultimately, these observed trends have serious implications for future cancer care and validate the need to study and monitor the effect of COVID-19 mitigation on cancer diagnosis and treatment moving forward,” the study authors wrote.

References:

1. London JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clinical Cancer Informatics. doi:10.1200/CCI.20.00068.

2. Nationwide Trends Show Fewer Cancer Patients Seeking Care Since Start of Pandemic [news release]. Philadelphia. Published July 27, 2020. Accessed July 28, 2020.