Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US

Abstract

ImportanceThe COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear.ObjectiveTo assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic.Design, Setting, and ParticipantsThis retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020.Main Outcomes and MeasuresThe main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years.ResultsOf 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (−19.0%) per hospital compared with 99 patients (−12.6%) at community hospitals and 110 patients (−12.8%) at integrated networks.Conclusions and RelevanceThis study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.

The impact of the California state lockdown during the COVID‐19 pandemic on management of patients with pancreatic ductal adenocarcinoma

“…This temporary period of early pandemic under-diagnosis was also noted by recent larger study of multiple high-risk gastrointestinal cancers. 15 There was no significant difference overall in time from symptom onset to the first clinical encounter. However, female patients detected an increase in time from symptom onset to referral to a specialty surgical oncology practice, postulated to occur due to delays in working up nonspecific symptoms for biliary tract-specific cancers.…”

Survival Among Patients With High-Risk Gastrointestinal Cancers During the COVID-19 Pandemic

“…These findings are contradictory to the hypotheses described in numerous prior studies, illustrating diagnostic and treatment delays that were projected to substantially affect survivorship . However, prior work using the NCDB to evaluate alterations in cancer treatment during the pandemic demonstrated a substantial decrease in time to treatment initiation which may contribute to the consistency in survival curves in the current study. Although this cohort of patients will be followed over time, it is unlikely that mortality rates at further time points will differ substantially, given the present results.…”

“… 13 Previous work analyzing the data collection infrastructure of the NCDB during the pandemic demonstrated that case abstraction remained intact, validating the use of this comprehensive, national database in future cohorts. 14 Although prior studies have evaluated national-level changes in cancer diagnosis 5 and treatment, 15 , 16 , 17 , 18 additional site-specific analyses are essential to understand what happened as a result of the pandemic and to anticipate changes in patient needs moving forward. We hypothesized that during the onset of the pandemic, there was a period of underdiagnosis as well as an increase in patients presenting with advanced-stage disease.…”