In a study of data from a Medicare fee-for-service population reported in JCO Clinical Cancer Informatics, Debra Patt, MD, PhD, MBA, and colleagues found that the COVID-19 pandemic has resulted in a “substantial decrease in cancer screenings, visits, therapy, and surgeries among older patients with cancer.”

Debra Patt, MD, PhD, MBA

Study Details

Data for the analysis were obtained from a proprietary provider clearinghouse registry representing approximately 5% to 7% of all Medicare fee-for-service claims submitted for adjudication between January 1, 2019, and July 31, 2020. Utilization of cancer care services in March to July 2020 was compared with that in the prepandemic period of March to July 2019.

Key Findings

A total of 6,227,474 Medicare fee-for-service claims were identified for the analysis.

Overall, there was a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation according to cancer type and site of service.

Decreases in screening for breast (range = -9% to -85%), colon (range = -25% to -75%), prostate (range = -3% to -56%), and lung (range = -49% to -75%) cancers were observed in each month from March through July 2020, with the greatest reductions being observed in April for mammography (-85%), colon (-75%), lung (-74%), and prostate (-56%) screenings.

Billing frequency for the top physician-administered oncology products had reductions in each month (range = -17% to -31%), with the greatest reductions in April (-26%) and July (-31%).

Billing for chemotherapy administration services in the professional setting (range = -19% to -31%) and the institutional setting (range = -10% to -31%) was reduced in each month, including reductions of 28% and 21% in April and 31% and 31% in July.

Breast (range = -31% to -71%), colon (range = -11% to -79%), and lung (range = -21% to -58%) biopsies were reduced in each month, with reductions in April and July being 71% and 31% for breast, 79% and 33% for colon, and 58% and 47% for lung biopsies.

Mastectomies (range = -33% to -56%), colectomies (range = -21% to -62%), and prostatectomies (range = -21% to -56%) were reduced in each month, with > 50% reductions in mastectomies in April, May, and June; in colectomies in April and May; and in prostatectomies in April.

Patient evaluation and management (E&M) visits were reduced for new patient visits (range = -29% to -70%, greatest reduction in April), established patient visits (range = -19% to -60%, greatest reduction in April), and hospital outpatient visits (range = -28% to -74%, greatest reduction in April).

Cancer-related hospitalizations were reduced by 30% in March, 41% in April, 36% in May, 31% in June, and 38% in July.

E&M visits were reduced by 19% to 61% (greatest reduction in April) for professional providers and by 28% to 71% (greatest reduction in April) for institutional providers.

Analysis including delivery of E&M services via telehealth only slightly reduced the decrease in overall E&M visits from 39% to 36% in March, 73% to 58% in April, 53% to 42% in May, 28% to 19% in June, and 38% to 31% in July. Professional providers delivered approximately 95% of the telehealth E&M services from April through July.

The investigators concluded, “The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.”

Dr. Patt, of Texas Oncology, Austin, is the corresponding author for the JCO Clinical Cancer Informatics article.

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