Data ‘raised the red flag’ regarding COVID-19 pandemic’s impact on cancer diagnoses
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Substantial reductions in procedures used to diagnose cancer and in new cancer diagnoses occurred across the U.S. because of the COVID-19 pandemic, according to a review of a large database of U.S. veterans published in Cancer.
Authors of the time-series study also developed a chart that can help health systems, institutions and states calculate the time and resources needed to address the backlog in diagnostic procedures and avoid the potential for worse long-term cancer results.
“Although we knew that curtailing all non-urgent health care during the first [COVID-19] surge would impact cancer detection, I have had an ongoing concern that subsequent secondary surges, regional differences in return to normalcy, and concerns of patients for potential exposure at medical facilities may collectively be curtailing cancer detection to persistently low levels,” Brajesh K. Lal, MD, associate professor of surgery at University of Maryland School of Medicine and director of endovascular surgery at Veterans Affairs Maryland Health Care System, told Healio.
Lal and colleagues set out to quantify decreases in encounters related to prostate, lung, bladder and colorectal cancers, procedures that facilitate their diagnosis, and new diagnoses in the COVID era compared with the pre-COVID era.
The analysis included data of more than 9 million veterans collected from VA electronic medical records from 1,244 VA medical facilities in the U.S. from 2016 through 2020.
Lal and colleagues estimated reductions in procedures and new cancer diagnoses in 2020, using 2018-2019 as a baseline. They calculated the absolute and percentage differences in annual volume and observed-to-expected volume ratios and generated heat maps and funnel plots of volume changes.
From 2018 to 2020, researchers identified 4.1 million cancer-related encounters, 3.9 million relevant procedures and 251,647 new cancers diagnosed. When compared with annual averages in 2018 through 2019, colonoscopies decreased by 45%, prostate biopsies by 29%, chest CT scans by 10% and cystoscopies by 21% in 2020.
In addition, new cancer diagnoses declined by 13% to 23%, depending on cancer type.
The declines continued despite reductions in pandemic-related restrictions, researchers reported. They noted that drops varied by state.
“Unfortunately, my suspicions were correct. Our health care services have still not recovered to full capacity in terms of cancer detection,” Lal told Healio. “This will likely have an adverse impact on long-term outcomes for cancers.”
Lal and colleagues created a nomogram that can be used to compute the number of months needed to clear the backlog and state/institution capacity to increase monthly procedures, as well as calculate the monthly capacity above baseline needed to clear the backlog.
Lal told Healio the findings have “raised the red flag” regarding the pandemic’s effect on cancer care in the United States, paving the way for further research to answer more questions.
“We now need to measure the length of the average delay in diagnosis and the actual consequences of this delay. Have ER visits increased? Has there been an increase in higher-grade cancers? Has there been increased mortality?
In addition, what are the key factors driving this deficit? It is likely multifactorial, but what is the relative contribution of each? Is it reduced health care personnel? Patient fears? Local hospital shutdowns?”
Lal added that COVID-19’s continued impacts and the introduction of new variants could continue to negatively impact cancer care.
“If these factors continue to persist, I am certainly concerned that we will not be able to recover from this deficit for a long time,” he said.
For more information:
Brajesh K. Lal, MD, can be reached at VA Medical Center and Department of Surgery, University of Maryland, 22 S. Greene St., Baltimore, MD 21201; email: blal@som.umaryland.edu.
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