U.S. mortality rates with cancer as the underlying or primary cause decreased during the first year of the COVID-19 pandemic, whereas mortality rates with cancer as a contributing cause increased, according to a new study published by Zhao et al in JCO Oncology Practice. The findings demonstrated that while decreased rates of cancer-related mortality in 2020 continued the trends of prior years, the increased rates of cancer-contributing mortality in 2020 reversed earlier trends.
Background
“Individuals living with cancer were at higher risk of COVID-19 infections and experiencing more severe symptoms [as a result of] their health conditions and treatment-related immune suppression,” explained lead study author Jingxuan Zhao, MPH, Associate Scientist II in the Department of Health Services Research at the American Cancer Society. “The stay-at-home orders and the discontinuation of non-emergency treatment to limit hospital capacity and reduce transmission at the beginning of the pandemic may have resulted in delayed cancer screenings, diagnoses, and treatments—and possibly contributed to increased mortality,” she added.
Study Methods and Results
In the new study, the investigators analyzed data from the Underlying and Multiple Cause of Death database from 2015 to 2020 and identified cases of cancer-related mortality with invasive cancer listed as the underlying or contributing cause of death. The investigators then compared age-standardized cancer-related mortality rates from 2020 with those from 2015 to 2019 and stratified the data by sex, race/ethnicity, urban or rural residence, and place of death.
The investigators projected 19,703 more deaths with cancer as a contributing cause in 2020 than expected based on historical trends. Mirroring COVID-19 pandemic peaks, the monthly mortality rates with cancer as a contributing cause first increased in April 2020 (rate ratio [RR] = 1.03, 95% confidence interval [CI] = 1.02–1.04), subsequently declined in May 2020 and June 2020, then increased again each month from July 2020 through December 2020 compared with 2019—with the highest rate ratio occurring in December 2020 (RR = 1.07, 95% CI = 1.06–1.08).
Conclusions
“More research is needed to better understand the reasons for such an increase in deaths with cancer as a contributing cause,” emphasized Dr. Zhao. “We need to continue monitoring the long-term cancer-related mortality trends and how the COVID-19 pandemic affected cancer diagnoses and receipt of care,” she concluded.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
