Study reveals ‘substantial drop’ in cancer treatments during start of COVID-19 pandemic
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Key takeaways:
- Decrease in overall treatments appeared largely due to decline in new cancer diagnoses, not treatment strategy changes.
- The results can provide a roadmap on providing care during future extreme weather events.
The number of cancer surgeries, chemotherapy treatments and radiation treatments declined dramatically during the first months of the COVID-19 pandemic, study findings published in JAMA Oncology showed.
Reductions in critical cancer treatments occurred largely because of a decrease in the number of new cancer diagnoses and not due to changes in cancer treatment strategies, according to researchers from the American Cancer Society.
“We found a substantial drop in the number of cancer treatments provided for every modality investigated. Nothing I’ve studied before had such a large impact on cancer care,” Leticia M. Nogueira, PhD, MPH, scientific director of health services research at American Cancer Society, told Healio. “However, the truly surprising finding was that, other than for early-stage breast cancer, these huge differences did not seem to reflect a change in cancer treatment strategy. Cancer patients still received the treatments recommended by guidelines.”
Background and methodology
The COVID-19 pandemic led to noticeable disruptions in access to cancer care for patients across the United States. Nevertheless, the extent of the impact the pandemic had on receiving cancer treatment remains unclear, according to researchers.
Nogueira and colleagues conducted a retrospective cohort study to evaluate changes in the absolute number, proportion and cancer treatment modalities provided to patients with newly diagnosed cancer during the first year of the COVID-19 pandemic.
The study used National Cancer Database information on adults (n = 3,504,342) diagnosed with any solid tumor between Jan. 1, 2018, and Dec. 31, 2020, with data analysis being conducted from Sept. 19, 2022, to July 28, 2023.
Researchers forecasted the expected number of procedures for each treatment modality in 2020, including surgery, radiotherapy, chemotherapy, immunotherapy and hormonal therapy. The analysis used historical data and the vector autoregressive method, with the difference between expected and observed numbers being evaluated using a generalized estimating equation.
Results
Compared with expected treatment numbers from previous years’ trends, researchers noted that approximately 98,000 fewer curative intent surgical procedures, 38,800 fewer chemotherapy regimens, 55,500 fewer radiotherapy regimens, 6,800 fewer immunotherapy regimens and 32,000 fewer hormonal therapies occurred during the first year of the COVID-19 pandemic than expected.
Further analysis showed large decreases in recommended treatments for early-stage cancers frequently detected through screening, including breast, colon and rectal cancers.
The largest absolute decrease occurred among surgical procedures for breast cancer. Investigators reported 22,208 fewer surgical procedures for breast cancer during the early pandemic when compared with what they expected for 2020, for an overall decrease of 12.3%.
The largest proportional decrease included an 18.3% drop in colorectal cancer surgeries.
Researchers also reported no statistically significant changes in the type of cancer treatments provided during the study period, apart from a significant decrease in the proportion of individuals who underwent breast-conserving surgery and radiotherapy and a significant increase in mastectomies for stage I breast cancer.
A potential study limitation included use of information from the National Cancer Database, a hospital-based cancer registry. This leaves open the possibility that not all patterns of care are represented for the entire U.S. population may be receiving.
Next steps
The noticeable decline in cancer treatments, due to a decrease in new cancer diagnoses, showed the ability of oncology professionals to still deliver cancer care despite serious obstacles, according to researchers. The results provide a roadmap for clinicians and physicians to follow in the event of future emergencies.
“To me, the most important take-home message is that despite the challenges with person-to-person interactions and the surge in health care needs during the first months of the pandemic, among patients who were diagnosed with cancer, oncology professionals seem to have been able to provide the recommended cancer care,” Nogueira said.
“Oncology professionals’ ability to provide recommended cancer care despite the challenges posed by the pandemic showed how we can work together and quickly adapt to solve issues that are prioritized,” she added. “Some of the lessons learned during the pandemic might be useful for preparing and responding to other types of emergencies, such as extreme weather events (hurricanes, floods, wildfires, etc.), which are impacting more and more health care facilities nationwide.”
References:
- New study shows fewer cancer surgeries, chemotherapy and radiation treatments during start of COVID-19 pandemic (press release). Available at: https://pressroom.cancer.org/releases?item=1277. Published Nov. 8, 2023. Accessed Nov. 15, 2023.
- Nogueira LM, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.4513.
For more information:
Leticia M. Nogueira, PhD, MPH, can be reached at 3380 Chastain Meadows Pkwy. NW S200, Kennesaw, GA 30144; email: leticia.nogueira@cancer.org.
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