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Nationwide Trends Show Fewer Patients With Cancer in the United States Seeking Care Since Start of the COVID-19 Pandemic


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Research published by London et al in JCO Clinical Cancer Informatics found significant decreases nationwide in the number of patients seen for cancer-related care as the COVID-19 pandemic progressed during the first few months of 2020. The most significant decline was seen in encounters related to new cancer incidences, which included screening, initial diagnosis, second opinions, and treatment initiation appointments.

“While it is not surprising that the pandemic has had a significant impact on patients seeking [cancer] care, it was important to test and quantify these trends using a large, institutionally agnostic dataset, as the results have important implications for future…patients and the potential burden on hospitals moving forward,” said senior study author Christopher McNair, PhD, Director of Cancer Informatics at the Sidney Kimmel Cancer Center – Jefferson Health (SKCC).

Methods

The research team leveraged the TriNetX platform to create a COVID and Cancer Research Network (CCRN). The CCRN is comprised of data from 20 health-care organizations representing over 28 million patients throughout the United States and includes aggregate data from electronic medical records such as diagnoses, procedures, laboratory testing, and demographics. Using the CCRN, the study team compared the number of patients with cancer-related encounters in January through April of 2019 with those in January through April of 2020.

Findings

Researchers identified a significant decline in patients with encounters associated with any neoplasm, including malignant, benign, and in situ diseases (-56.9%); new incidence neoplasms (-74%); malignant disease (-50%); and new incidence malignant disease (-65.2%). The researchers also looked at data from University Hospitals Plymouth NHS Trust in the United Kingdom, which showed similar trends. However, the researchers cautioned that more data are needed to compare trends outside the United States, as these findings are from a single hospital.

KEY POINTS

  • Researchers identified a significant decline in patients with encounters associated with any neoplasm, including malignant, benign, and in situ diseases (-56.9%); new incidence neoplasms (-74%); malignant disease (-50%); and new incidence malignant disease (-65.2%).
  • Mammograms declined 89.2% in April 2020 compared with April 2019; colorectal cancer screenings declined by 84.5% during the same period.

“While the decreases themselves were not unexpected, the magnitude of decline—while using a national cohort this large—was surprising,” commented Dr. McNair.

The researchers also looked at encounters by cancer type. Patient encounters decreased across all cancer types, although they observed a greater decrease related to melanoma (-51.8%), breast cancer (-47.7%), and prostate cancer (-49.1%) than lung cancer (-39.1%), colorectal cancer (-39.9%), and hematological cancers (-39.1%).

Additionally, the team also found that mammograms declined 89.2% in April 2020 compared with April 2019; colorectal cancer screenings declined by 84.5% during the same period. The researchers plan 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,” said Dr. McNair said.

The researchers will continue to look at trends throughout the summer and into the fall, especially as states are more drastically affected. 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, explained Dr. McNair.

"The most significant finding in our study was the considerable drop in cancer screenings."
— Christopher McNair, PhD

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The study authors concluded, “Trends seen in the CCRN clearly suggest a significant decrease in all cancer-related patient encounters as a result of the pandemic. The steep decreases in cancer screening and patients with a new incidence of cancer suggest the possibility of a future increase in patients with later-stage cancer being seen initially as well as an increased demand for cancer screening procedures as delayed tests are rescheduled.”

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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