Impact of COVID-19 on Cancer Care May Lead to Increase in Cancer Morbidity and Mortality

A new national study published in JCO Clinical Cancer Informatics indicated that the impact of coronavirus disease 2019 (COVID-19) on cancer care in the US has led to decreases and delays in identifying new cancers, as well as the delivery of treatment.¹

Moving forward, researchers suggested that if these problems remain unresolved, there will be an increase in cancer morbidity and mortality for years to come.

“If cancers are not diagnosed at an early stage, we could face rising death rates for several years to come,” co-author Michael Diaz, MD, assistant managing physician at the Florida Cancer Specialists & Research Institute (FCS) and president of the Community Oncology Alliance (COA), said in a press release.² “It is critical that adults with a family history of cancer and others who may be experiencing symptoms do not delay their screenings for the fear of being exposed to or contracting coronavirus. Medical practices now have numerous strategies in place to protect the safety and health of patients, doctors, nurses and other staff members.”

For this study, the investigators utilized a large medical claims clearinghouse database representing 5% to 7% of the Medicare Fee for Service (FFS) population in order to characterize changes in the use of cancer care services and to gain insight into the impact of COVID-19 on the patients with cancer in the US, including identification of new patients, gaps in access to care, and disruption of treatment journeys. Overall, 6,227,474 Medicare FFS claims were captured by the analysis.

Compared to the baseline period of March to July 2019, in March to July 2020 there was a substantial decrease in cancer screening, visits, therapy, and surgeries, though this varied by cancer type and site of service. Specifically, at the peak of the pandemic in April, screening for breast, colon, prostate, and lung cancer were all lower by 85%, 75%, 74%, and 56%, respectively.

Moreover, researchers also observed significant utilization reductions 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%). Additionally, a decrease in billing frequency was revealed for the top physician-administered oncology products, declining in both April (-26%) and July (-31%). Further, mastectomies were also steadily reduced from April through July, with colectomies comparably reduced in April and May and prostatectomies dipping in April and July.

“In the early months of the pandemic, many people chose or had to delay or even skip regular screenings, such as mammograms, prostate exam, PSA testing or colonoscopies, among others, for various types of cancer,” explained co-author Lucio Gordan, MD, president and managing physician at FCS, in the release. “This has resulted in later diagnoses for some patients and delays in beginning treatment. Oncologists are preparing their practices for significant impact in cancer patient outcomes due to these delays.”

However, one positive impact of COVID-19 revealed by the study was the rapid adoption of telehealth and other strategies by various community oncology practices.

“Community oncologists and their team members showed incredible resilience and resolve to deal with this severe crisis, by adopting telehealth very quickly, reorganizing workflows, enhancing safety processes at their clinics, and migrating staff to work from home, among other strategies,” Gordan added. “Although a decrease in services was inevitable, the resolve of these practitioners and staff handled and avoided what could have been a much worse situation.”

In order to effectively diagnose and manage cancer moving forward, the investigators recommended that stakeholders consider how to heighten awareness of the dangers of medical distancing and recover patients’, especially senior patients’, confidence in their ability to seek safe and appropriate care, including routine cancer screening and appropriate cancer treatment. According to the researchers, policies which promote access to cancer care and support the cancer ecosystem also have the potential to reduce the expected morbidity and mortality in this patient population.

Nevertheless, future studies remain necessary to help understand the impact of COVID-19 on specific patient populations.

References:

1. Pratt D, Gordan L, Diaz M, et al. The Impact of COVID-19 on Cancer Care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clinical Cancer Informatics. doi: 10.1200/CCI.20.00134

2. New Study Warns of Negative Impact COVID-19 is Having on Cancer Screenings, Diagnosis and Treatment [news release]. Fort Myers, Florida. Published October 28, 2020. Accessed October 29, 2020. https://flcancer.com/en/articles/new-study-warns-negative-impact-covid-19-having-cancer-screenings-diagnosis-and-treatment/