New cancer identification and treatment delivery decreased or was delayed as a result of the COVID-19 pandemic, according to a recent study in JCO Clinical Cancer (2020. doi:10.1200/CCI.20.00134).
In anticipation of increasing rates of coronavirus infections, many health care providers made short-term adjustments to cancer care delivery. The changes to care included temporarily discontinuing nonemergent cancer screenings, shifting to telehealth, and delaying surgeries and other in-office services. Since the start of the pandemic, professional societies have released guidance to amend care guidelines to offset these changes.
“When cancer becomes more advanced before it is detected it becomes a ticking time bomb. The decrease in screenings, diagnosis, and treatments this year will lead to later stage cancers for patients, increasing morbidity and mortality for years to come. We need to detect cancers and stop them before it is too late. We need to alert all patients that they need to stop medical distancing and get appropriate screening and health care,” said Debra Patt, MD, PhD, Texas Oncology.
The study used a retrospective analysis to determine the trends in cancer care delivery during the first half of 2020 across settings of care to determine the lag time behind cancer care management in 2019. Data were gathered from a proprietary provider clearinghouse registry containing 5%-7% of all Medicare fee-for-service claims that were submitted between January 1, 2019 and July 31, 2020 and compared statistically using a Wilcoxon rank-sum test.
The researchers determined a substantial decrease in cancer screening for breast, colon, prostate, and lung cancer by 85%, 75%, 74%, and 56%, respectively. Hospital outpatient Evaluation and Management visits were all down by at least 60%. Billing dropped at least 26%. Mastectomies, colectomies, and prostatectomies were also reduced. In addition, cancer-related hospitalizations declined by at least 30%.
The expanded use of telemedicine mitigated the drop in Evaluation and Management visits by 20%, which was largely driven by professional providers.
As the pandemic continues, the impact on cancer care will continue to be monitored.
“Policies to promote access to cancer care and support the cancer ecosystem have the potential to reduce the expected morbidity and mortality in this patient population,” wrote Dr Patt and colleagues.—Lisa Kuhns
