Impact of the COVID-19 Pandemic on Treatment Patterns for Patients With Metastatic Solid Cancer in the United States

Abstract

Background The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic’s impact on time to treatment initiation and treatment selection for patients newly diagnosed with metastatic solid cancer. Methods We used an electronic health record-derived longitudinal database curated via technology-enabled abstraction to identify 14,136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at approximately 280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on time to treatment initiation, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy. Results The adjusted probability of treatment within 30 days of diagnosis was similar across periods (January-March 2019 = 41.7%, 95% confidence interval [CI] = 32.2% to 51.1%; April-July 2019 = 42.6%, 95% CI = 32.4% to 52.7%; January-March 2020 = 44.5%, 95% CI = 30.4% to 58.6%; April-July 2020 = 46.8%, 95% CI = 34.6% to 59.0%; adjusted percentage-point difference-in-differences = 1.4%, 95% CI = -2.7% to 5.5%). Among 5,962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences= 1.6%, 95% CI = -2.6% to 5.8%). There was no meaningful effect modification by cancer type, race, or age. Conclusions Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not impact time to treatment initiation or treatment selection for patients with metastatic solid cancers.

Changes in multiple myeloma treatment patterns during the early COVID-19 pandemic period

“…Further, the mainstay of MM treatment is systemic chemoimmunotherapy whereas solid tumors are often managed with surgery and/or chemoradiotherapy, which may have presented additional care coordination challenges. Our study is the first report describing patterns of care in MM during early pandemic and is consistent with a prior US study in metastatic cancers wherein the COVID-19 pandemic did not impact TTI or treatment selection [ 15 ].…”

Cancer treatment and survivorship statistics, 2022

“…Although many delays are related to radiotherapy or chemotherapy, one study of Medicare recipients reported that surgical procedures likewise declined in the first few months of the pandemic 219 . Although some data are available, it is still too early to know the extent to which COVID‐19–related treatment delays will influence cancer survival 220‐222 …”

“…219 Although some data are available, it is still too early to know the extent to which COVID-19-related treatment delays will influence cancer survival. [220][221][222] For those transitioning to long-term care in the COVID-19 era, the pandemic has substantially impeded the process of finding a new normal as a cancer survivor. Similar to the general population, posttreatment survivors have experienced reduced contact with health care providers; increased financial concerns; a rise in unhealthy behaviors associated with increased cancer risk, such as physical inactivity, smoking, and alcohol use; and elevated anxiety and depression.…”

Does COVID‐19 pandemic impact cancer outcomes in metastatic setting? A comparative cohort study among metastatic patients treated at day care hospital

“…In other cases, the adaptations in oncological treatment program were weighted by the need to continue therapies aiming at curing and treating cancer, as mortality from untreated active malignancy remains extremely high and by the modest risk of severe COVID‐19 due to systemic anticancer therapy 30,31 . In an American cohort study that focused on metastatic solid cancers, there were no delays in systemic treatment initiation or preference against use of myelosuppressive therapies 32 . In our study, capacities of the day care hospital, although modified, were not overwhelmed and adaptations of treatment plans were made for a selected group of metastatic patients of good prognosis (mainly monotherapy with immunotherapy/targeted therapy for patients with a good performance status) while patients with a poorer prognosis treated with chemotherapy or combined treatments continued their program.…”