COVID-19 Decreased, Delayed Cancer Identification and Treatment Delivery, Study Shows

Significant short-term disruptions in care delivery were observed during the coronavirus disease 2019 (COVID-19) pandemic, due to limited patient access to in-person care, a study published in JCO Clinical Cancer Informatics showed.This may have long-term consequences in morbidity and survival implications for patients who were unable to receive cancer screening, treatment, and surgery throughout this time, and lead to a stage migration to more advanced cancer at diagnosis, according to the study authors.¹

During the pandemic, stay at home orders and subsequently, patients’ reluctance to go to medical facilities brought the need for telemedicine, as well as temporary discontinuation of non-emergency visits for cancer screening and treatments. Surgeries and other in-office cancer services were delayed. To understand the impact of COVID-19 on patients’ survival, this analysis looked at trends across care settings at the utilization of cancer services, specifically screening and treatment.

“When cancer becomes more advanced before it is detected, it becomes a ticking time bomb,” lead study author, Debra Patt, MD, PhD, executive vice president, policy and strategic initiatives at Texas Oncology, and member of the Community Oncology Alliance (COA) Board of Directors, said in a statement.² “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.”

The retrospective analysis investigated 6,227,474 Medicare Fee for Service (FFS) claims and found a significant decrease in breast, colon, lung, and prostate cancer screenings in 2020 compared with the year before. The most significant drop occurred in April for mammograms, at -85%. Screenings for lung, colon, and prostate followed at -75%, -74%, and -56%, respectively.

In April and July, there were reductions in cancer biopsies for breast cancer at -71% and -31%, colon cancer at -79% and -33%, and lung cancer at -58% and -47%, respectively. April through July also saw a consistent reduction in mastectomies and prostatectomies; April and May also had a reduction in colectomies.

“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,” Lucio Gordan, MD, study co-author, president and managing physician of Florida Cancer Specialists & Research Institute (FCS), and member of the COA Board of Directors, said in a press release.³ “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.”

For the leading physician-administered oncology products, there was a decrease in billing frequency in April at -26% and in July at -31%. Billing for chemotherapy administration services also decreased in the professional and institutional setting in April, May, and July; In April, billing in professional settings was down -28%, and institutional was down -21%, May was down -30% and -21%, respectively, and July was down 31% in both.

Additionally, patient evaluation and management (E&M) visits were reduced, the greatest drop being in April for outpatient hospital E&M visits at -74%. These drops were higher, at -70%, for new patient E&M visits versus established patient E&M visits, at -60%. There was also a decline in cancer-related hospitalizations in March, at -30%, April at -41%, May at -36%, June at -31% and July at -38%.

There was a greater reduction in the delivery of cancer care for institutional providers, who had the greatest reduction in E&M visits in April for institutional providers at -71% compared with professional providers at -61%.

Study author, FCS assistant managing physician, and president of COA, Michael Diaz, MD, echoed Gordan’s concerns. “If cancers are not diagnosed at an early stage, we could face rising death rates for several years to come,” he said. “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.”

Although the utilization of telemedicine was increased, E&M services delivered through telemedicine only mitigated the drop in E&M visits in April from -73% to -58%. The usage of telemedicine had been mostly by professional providers, who provided about 95% of the telemedicine E&M services from April to July.

“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. 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,” Gordon said.

These researchers and their fellow study authors suggest stakeholders consider how to heighten awareness of the dangers of medical distancing and mend the elderly populations’ confidence in seeking safe cancer care, such as routine cancer screening and treatment to avoid negative impacts on their mortality due to cancer. They also promoted creating policies to encourage patients seek access to cancer care to reduce the expected morbidity and mortality for patients with cancer.

_References:

_{1. Patt 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 Clin Cancer Inform. Published online doi:10.1200/CCI.20.00134}

_{2. New study finds COVID-19 substantially reduced cancer screenings, diagnosis, and treatments in 2020. News release. Community Oncology Alliance. Published October 21, 2020. Accessed November 6, 2020. https://bit.ly/3ey3OUW}

_{3. New study warns of negative impact COVID-19 is having on cancer screenings, diagnosis and treatment. News release. Florida Cancer Specialists & Research Institute. Published October 28, 2020. Accessed November 6, 2020. https://bit.ly/38gUXG7}