COVID-19 pandemic may have negative impact on accuracy of cancer research data
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Key findings:
- The first year of the pandemic saw 14.4% fewer cancer cases reported in the U.S. compared with previous year.
- The decrease could have several downstream effects if not accounted for properly, researchers noted.
The number of individuals diagnosed with and treated for cancer in the United States decreased 14% during 2020 compared with the previous year, a study published in JAMA Surgery showed.
The results suggest issues related to the COVID-19 pandemic have skewed data collected by National Cancer Database (NCDB). Researchers who use the data as part of future research models should take steps to account for what investigators called “pandemic year aberrations” in 2020.
“This work represents a high-level overview and cautionary tale for users of NCDB data in the future,” Sharon S. Lum, MD, MBA, professor and chair of the department of surgery at Loma Linda University School of Medicine, told Healio. “All tumor sites and patient populations were impacted by the first year of the pandemic, and we will need to continue to watch for further downstream effects.”
Background
The NCDB —a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and American Cancer Society — receives information on diagnosis and treatment of new cancer cases in real time from participating accredited programs, according to Lum.
Year-over-year data from the database have been reliably stable, but disruptions from the first year of the pandemic were expected to influence reporting patterns, Lum added.
“As clinicians, we know that patients did not come in to get cancer screening and that normal care for patients with cancer tremendously altered,” she said. “We wanted to look at patterns of cancer diagnoses in the NCDB in this first year of the pandemic because many people rely on the NCDB data for quality improvement, CoC accreditation and research.”
Methodology
Lum and colleagues sought to evaluate changes in reporting trends of cancer cases the NCDB recorded during 2020, the first year of the COVID-19 pandemic. They aimed to confirm a change in the trend’s trajectory so that researchers who subsequently use 2020 NCDB data sets can adjust their research models to account for pandemic-related effects.
The investigators evaluated adults diagnosed with cancer and/or those who received their first-line treatment at a participating facility from 2018, to 2020. The researchers collected data on diagnoses from 17 tumor sites, in addition to tumor stage and demographic information.
Key findings
Researchers identified a total of 4,045,097 adult cancer cases (median age, 66 years; interquartile range, 57-74; 53.7% women) reported to the NCDB between 2018 and 2020. Year-by-year adult cancer cases included 1,392,556 in 2018, 1,429,320 in 2019 and 1,223,221 in 2020.
They found the number of cases the NCDB recorded in 2020 to be 14.4% lower than the previous year, before the start of the COVID-19 pandemic. This stands in stark contrast to the prepandemic year-over-year change of a 2.6% increase from 2018 to 2019.
Investigators also observed a decrease in the monthly number of reported cases to the NCDB early in the pandemic, which included March to May 2020. This trend reached its lowest point in April 2020 and partially recovered by the middle of the year, the researchers noted. However, the number of monthly reported cases did not return to the levels expected during prepandemic years, except for 1 month later in 2020.
Researchers reported a decrease in number of cases diagnosed in 2020 across all 17 primary cancers sites they evaluated, ranging from a 10.5% decrease in head and neck cancer to a 20.6% decrease in thyroid/endocrine cancer.
The proportion of early-stage disease detected also decreased during the early months of the pandemic, whereas the number of late-stage cases increased. Investigators reported considerable variation in reported vs. expected cases based on stage and disease site.
Notably, researchers observed significant differences in overall vs. expected proportions of reported cancer cases based on race, ethnicity, sex, insurance type, geographic location, education and income, although they did not find consistent patterns.
Clinical implications
The 14% fewer cancer diagnoses in 2020 represents approximately 200,000 patients yet to be accounted for, according to Lum.
“We don't yet know what happened to these patients,” she told Healio. “We are waiting to see if they are coming back in for treatment at more advanced stages.”
NCDB data are used for wide-ranging research and the decrease in cancer cases reported during the first year of the pandemic will have numerous downstream effects if not accounted for properly, Lum added.
“Researchers need to interpret 2020 NCDB data in the context of the pandemic and include comparisons to prior years, and in the future to postpandemic years,” she said. “They will also need to account for delays in treatment or mortality due to COVID-19 at an individual level and the effects on the pandemic on overall health care delivery in a time of scarce resources.”
The research by Lum and colleagues has revealed an array of negative pandemic-related effects on cancer care beyond the overall number of cases identified, according to David J. Bentrem, MD, MS, professor of surgery at Northwestern University Feinberg School of Medicine, and Stephen F. Sener, MD, professor of surgery at Keck School of Medicine of USC. These included less detection of early-stage disease, more detection of late-stage disease, and further exacerbation of disparities in cancer treatment and screening based on race and ethnicity.
“As U.S. President Joe Biden’s administration ends the national emergency and public health emergency on May 11, it is important to evaluate the unintended consequences of the necessary decisions made in response to the pandemic,” they wrote in an accompanying editorial.
“The members of the Commission on Cancer and staff for Cancer Programs and the Division of Research and Optimal Patient Care at the American College of Surgeons should be commended for this valuable report defining the risks of care deferred during the pandemic,” they added. “We must continue to find ways to limit its effect on disadvantaged groups and communities so to not further increase disparities in cancer care.”
References:
- Bentrem DJ, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2023.0659.
- Lum SS, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2023.0652.
For more information:
Sharon S. Lum, MD, MBA, can be reached at Loma Linda University School of Medicine, 11175 Campus St., CP21111, Loma Linda, CA 92354; email: slum@llu.edu.
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