Reporting on how deferred care worsened outcomes for patients with lung cancer when the COVID-19 pandemic first surged in the spring of 2020, Robert M. Van Haren, MD, MSPH, FACS, and colleagues explained that they have identified a framework that could help people with serious health conditions keep up their appointments during the current surge. The study has been selected for the 2020 Southern Surgical Association Program and is published as an article in press in the Journal of the American College of Surgeons.

Robert M. Van Haren, MD, MSPH, FACS

CT Screening Analysis

The researchers compared monthly visits for low-dose computed tomography (CT) screening for lung cancer during the 3 months in which COVID-19 restrictions were in place with the number of monthly visits from the prior 3 years. Low-dose CT is an imaging modality that may reduce mortality from lung cancer by at least 20% in high-risk patients. The institution studied in the analysis—the University of Cincinnati—suspended low-dose CT on March 13, 2020, and began a phased reopening on May 5, with a full opening on June 1.

“We had 800 scans cancelled during that time and even during the resumed period, we had a decreased total volume of patients scanned and also noted a decreased number of new patients who were scanned for their lung cancer screening,” said lead author Dr. Van Haren, Assistant Professor and thoracic surgeon at the University of Cincinnati College of Medicine and a member of Cincinnati Research in Outcomes and Safety in Surgery within the Department of Surgery.

The institution averaged 146 low-dose CT tests a month before COVID-19 compared with 39 in March to June of this year (P < .01), with new patient monthly averages falling from 56 to 15 (P < .01).

“Also, when we resumed our operations, we found that new patients were less likely to come…to our screening program,” added Dr. Van Haren. The researchers reported that new patient monthly low-dose CT rates have remained low—despite resuming full operations.

“We also found that patients were more likely not to show up for their CT appointments, and this rate was again significantly increased compared with baseline,” said Dr. Van Haren. The no-show rate went from 15% before COVID-19 restrictions to 40% afterwards (P < .04).

Further, when full operations resumed in June 2020, 29% of patients were found to have lung nodules suspicious for malignancy compared with 8% in the pre–COVID-19 period (P < .01). That meant more patients were referred to a specialist for either biopsy or surgery as their suspected cancer entered a more critical phase.

These poor rates of screening may reflect patient fears about coming into the hospital during the pandemic, although the study did not look at that concern specifically, explained Dr. Van Haren.

“We've done two things to try to deal with that situation,” said Dr. Van Haren. “One was that we made operational changes to ensure that screening is safe, and we made a big emphasis within our program and with our nurses and coordinators to educate patients about those changes and to really get the message out that screening is safe.”

The key operational change was shifting the setting for the low-dose CT from the hospital to an outpatient center, but other changes included enforcing social distancing in the waiting rooms and in the scanning areas, and spacing appointments farther apart to allow for appropriate cleaning of those areas.

“Our results are important and suggest that it's critical to continue cancer screening operations, such as our lung cancer screening, during this pandemic,” said Dr. Van Haren. “It's maybe more important now as we continue to undergo another surge of COVID-19 cases throughout the country.”

He concluded, “We have to make sure as health-care providers that we're taking care of patients who have COVID-19 and along with the rest of the population who don't have COVID-19, and that those two patient populations can safely co-exist and receive treatment.”

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