PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION 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.

Technology is making the routine screening of symptoms and the measurement of quality of life (QoL) more feasible at the point of care. However, most existing symptom screening scales and QoL measures were not developed for clinical use and were not formatted and validated for administration through computerized mediums. The Cancer Care Monitor (CCM) is a symptom-based scale developed for administration on pen-based computers. This study is an initial evaluation of the reliability and validity of the CCM. Three samples of adult outpatients provided ratings on 38 physical, psychological, and functional oriented items of the CCM that comprise six symptom scales and one global QoL index. All additive scales are converted to normalized T scores. Reliability was examined through internal consistency and confirmatory factor analysis. Convergent and divergent validity were examined by comparing CMM scores to established measures of corresponding constructs and physician judgments. Alternative forms reliability was established by comparing paper and pencil administration with computer administration. Internal consistency reliability and factor analyses confirmed the structure of the CCM as comprising six primary symptom scales and one global QoL index. Internal consistency reliabilities ranged from 0.80 to 0.89. The pattern of correlations between CCM scales and established measures supported the convergent and divergent validity of the CCM scales. Alternate forms reliability based on paper and computer forms of the CCM scales was high. Patients indicated a preference for the computer-administered version. Results suggest that CCM items can be scored as a reliable and valid measure of constructs related to physical, psychological, and functional status, and global health-related QoL in adult cancer patients. Future studies should replicate and further evaluate the properties of the CCM, especially in relation to clinical utility.

Background: Neutropenia is a common toxicity in chemotherapy but detailed information about how neutropenia is associated with changes in patients' quality of life is not readily available. This prospective study interviewed patients with grade 4 neutropenia to provide qualitative information on patients' experience of developing and coping with grade 4 neutropenia during a cycle of chemotherapy.

This year, we mark the 40-year anniversary of the National Cancer Act. The law expanded the scope and funding of the National Cancer Institute, among other initiatives, in what has become known as the "war on cancer." Looking back over the years, it is indisputable that we have made dramatic inroads in fighting cancer. A just-released report by the Centers for Disease Control and Prevention estimates that the number of survivors of cancer in the United States has increased from 3 million in 1971 to 11.7 million in 2007. 1 Yet cancer still claims the lives of more than .5 million Americans each year and ranks close behind cardiovascular disease as the leading cause of death. 2 In this article, we offer our perspectives on how the war on cancer is going from the clinical and policy frontlines and postulate on what the future holds. Battles Have Been Won With Some Impressive ResultsThere is little debate that cancer care delivery in the United States has evolved dramatically in the past 40 years and has produced impressive results. Aided by therapeutic and delivery advances, fellowship-trained oncologists have set up private practices across the country that have moved cancer care from the inpatient, academic center complex to the outpatient, community setting. Today, four of five Americans battling cancer are treated close to home in independent practices or those affiliated with hospitals. 3 The community model of cancer care has provided high-quality, affordable, and accessible treatment to patients with cancer.Oncologists have been aided by significant advances in how they diagnose, treat, and manage cancer. For instance, the death rate from breast cancer decreased by approximately 2% per year between 1990 and 2006. 4 The multifactorial reasons for this decrease include widespread use of screening tests-such as mammography, which has increased early detection-as well as improvement in treatment in the adjuvant and metastatic setting. We can now realistically talk about certain metastatic cancers as chronic diseases given that patients often live many years with good quality of life.These encouraging results extend to the entire population. The increase in cancer mortality rates has been reversed, and 5-year survival rates for the United States demonstrate the strength of our cancer care delivery model. For example, American women have a 63% chance of living for at least 5 years after a cancer diagnosis compared with 56% for European women; American men have a 5-year survival rate of 66% compared with a rate of only 47% for European men. 5

No abstract