Trends in Low-Value Cancer Care During the COVID-19 Pandemic

Abstract

Background Low-value services are common in cancer care. The onset of the COVID-19 pandemic caused a dramatic decrease in health care utilization, leading many to suspect that low-value cancer services may decrease. Methods In this retrospective cohort study, we used administrative claims from the HealthCore Integrated Research Environment, a repository of medical and pharmacy data from US health plans representing over 80 million members, to identify 204,581 patients diagnosed with breast, colorectal, and/or lung cancer between January 1, 2015, and March 31, 2021. We used linear probability models to investigate the relation between the onset of COVID-19 pandemic and 5 guideline-based metrics of low-value cancer care: 1) Positron Emission Tomography/Computed Tomography (PET/CT) instead of conventional CT imaging for initial staging; 2) conventional fractionation instead of hypofractionation for early-stage breast cancer; 3) non-guideline-based antiemetic use for minimal-, low-, or moderate-to-high-risk chemotherapies; 4) off-pathway systemic therapy; and 5) aggressive end-of-life care. Results Among 204,581 patients, the mean [SD] age was 63.1 [13.2], 68.1% were female, 83,593 (40.8%) had breast cancer, 56,373 (27.5%) had colon cancer, and 64,615 (31.5%) had lung cancer. Rates of low-value cancer services did not exhibit meaningful declines during the pandemic: PET/CT imaging, adjusted percentage point difference 1.87 (95% CI -0.13 to 3.87); conventional radiotherapy, adjusted percentage point difference 3.93 (95% CI 1.50 to 6.36); off-pathway systemic therapy, adjusted percentage point difference 0.82 (95% CI -0.62 to 2.25); non-guideline-based antiemetics, adjusted percentage point difference -3.62 (95% CI -4.97 to -2.27); aggressive end-of-life care, adjusted percentage point difference 2.71 (95% CI -0.59 to 6.02). Discussion Low-value cancer care remained prevalent through the pandemic. Policymakers should consider changes to payment and incentive design to turn the tide toward higher-value cancer care.