Patterns of cancer-related deaths changed during first year of COVID-19 pandemic
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Key takeaways:
- The death rate with cancer as the underlying cause decreased from 2019 to 2020.
- In contrast, the death rate with cancer as a contributing cause increased during the period.
Deaths with cancer as either an underlying or primary cause decreased across the United States during the first year of the COVID-19 pandemic when compared with the previous year, according to data published in JCO Oncology Practice.
However, mortality rates with cancer as a contributing cause in 2020 increased over 2019, a reversal of the trend observed in the previous 5 years, researchers wrote.
“Individuals living with cancer were at higher risk [for] COVID-19 infection and experiencing more severe symptoms due to their health conditions and treatment-related immune suppression,” Jingxuan Zhao, MPH, senior associate scientist of health services research at the American Cancer Society, said in a press release. “The stay-at-home orders and the discontinuation of nonemergency treatment to limit hospital capacity and reduce transmission at the beginning of the pandemic may have resulted in delayed cancer screenings, diagnoses and treatments, and possibly contributed to increased mortality.”
Background and methodology
Researchers sought to examine changes in cancer-related deaths during the first year of the COVID-19 pandemic throughout the U.S. Their analysis included deaths with cancer as the primary or a contributing cause as listed in the Multiple Cause of Death database (2015-2020).
Researchers compared age-standardized cancer-related annual and monthly mortality rates for January to December of 2020 with rates from 2015 to 2019, stratified by sex, race/ethnicity, urban rural residence and place of death.
Results
Researchers reported a lower death rate (per 100,000 person-years) with cancer as the underlying cause in 2020 vs. 2019 (144.1 vs. 146.2) — continuing a trend of annual decreases from 2015 to 2019.
However, data showed an increase in the death rate with cancer as a contributing cause in 2020 vs. 2019 (164.1 vs. 162), reversing a previous trend from 2015 to 2019.
Researchers projected 19,703 additional deaths with cancer listed as a contributing cause than expected according to historical trends.
Monthly death rates with cancer as a contributing cause increased in April 2020 (rate ratio = 1.03; 95% CI, 1.02-1.04) before declining in May and June 2020, with increases each following month through December 2020 compared with 2019. The highest rate ratio occurred in December (1.07; 95% CI, 1.06-1.08).
Next steps
Continued monitoring of long-term cancer-related mortality trends will be necessary to further understand the effects of delays in diagnoses and care due to the COVID-19 pandemic, researchers wrote.
“More research is needed to better understand the reasons for such an increase in deaths with cancer as a contributing cause,” Zhao said in the press release. “We need to continue monitoring the long-term cancer-related mortality trends and how the COVID-19 pandemic affected cancer diagnosis and receipt of care.”
References:
- New study shows more deaths with cancer as contributing cause during first year of pandemic (ACS press release). Available at: pressroom.cancer.org/releases?item=1202. Published April 11, 2023. Accessed April 19, 2023.
- Zhao J, et al. JCO Oncol Pract. 2023;doi:10.1200/OP.22.00522.
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