Research from the Sidney Kimmel Cancer Center -- Jefferson Health (SKCC) found significant decreases nationwide in the number of patients being seen for cancer-related care as the COVID-19 pandemic progressed during the few first months of 2020. The most significant decline was seen in encounters related to new cancer incidences, which included screening, initial diagnosis, second opinion, and treatment initiation appointments.
Anecdotal reports and physician surveys have suggested dramatic declines; however, this study, which was published in JCO Clinical Cancer Informatics, is the largest to date to measure the effects of the pandemic on normal cancer care activities.
"While it is not surprising that the pandemic has had a significant impact on patients seeking care, it was important to test and quantify these trends using a large, institutionally agnostic dataset, as the results have important implications for future cancer patients and the potential burden on hospitals moving forward," said Christopher McNair, PhD, Director of Cancer Informatics at SKCC and senior author of the study.
McNair, along with Jack London, PhD, Research Professor Emeritus of Cancer Biology at Thomas Jefferson University, and colleagues leveraged the TriNetX platform to create a COVID and Cancer Research Network (CCRN). The CCRN is comprised of data from 20 healthcare 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.
McNair and team 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.
"While the decreases themselves were not unexpected, the magnitude of decline, while using a national cohort this large, was surprising," McNair said.
The researchers also looked at these 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, McNair and colleagues also found that mammograms declined 89.2% in April 2020 compared with April 2019 and 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," McNair said.
SKCC is participating in several key initiatives designed to help elucidate how COVID-19 affects cancer patients and clinical care, including the COVID-19 and Cancer Consortium (CCC19) and the American Society of Clinical Oncology (ASCO) Survey on COVID-19 in Oncology Registry. CCC19 is an international registry database that is tracking outcomes among cancer patients who have also been diagnosed with COVID-19. The ASCO Registry is collecting baseline and longitudinal data from oncology practices across the United States to examine the how the virus is affecting cancer care delivery and patient outcomes.
These registries are important in order to understand both short- and long-term impacts of the trends seen here, according to McNair.
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, McNair said.
"These findings are truly striking, as modeling from the National Cancer Institute has predicted thousands of expected increases in cancer death as a result of deferred breast and colorectal screening alone," said Karen E. Knudsen, MBA, PhD, Executive Vice President of Oncology Services, Jefferson Health, and Enterprise Director of the Sidney Kimmel Cancer Center. "This report is a nationwide call to arms, underscoring the urgent need to resume cancer screening and early detection."
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