Investigators have uncovered that fewer surgical, chemotherapy, and radiation treatments may have been performed in patients with cancer during the first months of the COVID-19 pandemic, according to a recent study published by Nogueira et al in JAMA Oncology. The new findings may be attributable to the significant deficits in the number of cancer diagnoses made during the early pandemic rather than to changes in cancer treatment strategies.
Study Methods and Results
In this recent retrospective cross-sectional study, the investigators used the National Cancer Database to examine the data of 3.5 million patients—1.2 million from 2018, 1.2 million from 2019, and 1 million from 2020—aged 18 and older who were diagnosed with solid tumors between January 2018 and December 2020. The expected number of procedures for each treatment modality (surgery, radiation therapy, chemotherapy, immunotherapy, and hormonal therapy) in 2020 was calculated using historical data from January 2018 to December 2019. The reported deficits in treatment reflected the difference between expected and observed numbers.
Compared with the number of expected treatments from previous years’ trends, physicians initiated approximately 98,000 fewer curative-intent surgeries, 38,800 fewer chemotherapy regimens, 55,500 fewer radiation therapy regimens, 6,800 fewer immunotherapy regimens, and 32,000 fewer hormonal therapies in 2020. For the majority of cancer sites and stages evaluated, the investigators found no statistically significant changes in the type of cancer treatment provided during the first year of the COVID-19 pandemic—the exception being a statistically significant decrease in the proportion of patients receiving breast-conserving surgery and radiation therapy with a simultaneous statistically significant increase in the proportion of patients undergoing mastectomy for the treatment of stage I breast cancer during the first months of the COVID-19 pandemic.
Conclusions
“These findings are very concerning. We knew the COVID-19 pandemic led to disruptions in access to health care, including cancer care, but we’re now beginning to see the full extent of the damage,” underscored lead study author Leticia Nogueira, PhD, MPH, Scientific Director of Health Services Research at the American Cancer Society. “More studies still need to be done concerning cancer care and disruptions during the pandemic, mainly if these treatment deficits resulted in changes in cancer survival and mortality. Future studies should also evaluate whether clinical, socioeconomic, and facility characteristics are associated with changes in cancer treatments during the pandemic,” she concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
