Cancer detection rates improved the second year of the pandemic, but deficits remained
Click Here to Manage Email Alerts
Key takeaways:
- Cancer diagnoses, which dropped significantly in 2020, generally recovered to pre-pandemic expectations in 2021.
- Disparities persisted for certain cancer types and for individuals who live in rural communities.
Cancer diagnoses fell significantly below expectations in 2020 due to the COVID-19 pandemic but recovered to projected levels the following year, according to results of a cross-sectional study.
However, although overall detection rebounded in 2021, deficits remained for some cancer types. Detection rates also lagged behind expected levels for individuals in most rural counties in the United States.
“Moving forward, we need to make sure that cancer detection continues to improve in order to make sure that all of the potentially missed cancer cases during the early part of the pandemic are detected,” Uriel Kim, MD, PhD, MBA, resident physician at Cedars-Sinai Medical Center, told Healio. “It is also important to make sure that we are able to reconnect patients with routine care and specialized cancer services; otherwise, there could be a surge of patients with more severe, metastatic cancer in the future.”
Background and methods
Cancer diagnoses decreased approximately 9% in 2020, according to study background. This included a near-50% drop from March to May of that year.
“The COVID-19 pandemic was obviously hugely disruptive to the delivery of health care,” Kim said. “We thought it was important to evaluate [how] cancer detection recovered in [2021], the second year of the pandemic. Previous investigations have largely focused on just the first year of the pandemic.”
Kim and colleagues used trend modeling and SEER data to compare expected vs. actual incidence of cancer in 2020 and 2021.
Results and next steps
Researchers identified 15,831,912 people (median age, 65 years; interquartile range, 56-75; 51% men; 72.4% white, 11.1% Hispanic, 10.4% Black) diagnosed with cancer from 2000-2021.
Investigators trained the trend model on the 14.2 million people diagnosed between 2000 and 2019.
They then used the model to project expected cancer incidence in 2020 and 2021, and they compared that number with the observed number of cancer cases diagnosed (759,810 in 2020 and 825,645 in 2021).
Cancer cases diagnosed in 2020 fell substantially short of expectations (418.9 cases vs. 458.12 cases per 100,000 population; percentage difference = 8.6%; 95% CI, 9.1 to 8.1). The estimated deficit equated to 125,167 cases.
In 2021, incidence nearly met projections (458.33 cases vs. 459.06 cases per 100,000 population; percentage difference = 0.2; 95% CI, 0.7 to 0.4). The expected shortfall translated to 2,764 diagnoses.
In 2020, subgroup analyses showed a significant decrease in cancer cases among men with localized cancer, as well as among people who lived in counties with low poverty rates, high rates of non-United States-born residents and higher education levels. They also observed larger decreases in incidence in communities on the extreme ends of the rural-urban range.
Diagnoses for most of those subgroups rebounded to approximately expected levels in 2021, except for those living in rural communities (percentage difference = -4.9%; 95% CI, 6.7 to 3.1).
Rates of gallbladder, eye and orbital cancers stayed depressed from 2020 to 2021.
Diagnoses of larynx, lung and bronchus, soft tissue, kidney and renal pelvis, and thyroid cancers increased from 2020 to 2021 but remained below projections.
Cancer types that had the greatest disparity between estimated incidence and actual diagnoses for both years combined included lung cancer and bronchus cancer (24,940 cases), prostate cancer (14,104) and melanoma (10,274).
Researchers acknowledged study limitations, including lack of a unified database that would have encapsulated 100% of the nation’s population.
Future studies should investigate how the COVID-19 pandemic impacted cancer mortality, Kim said, though he added “it may take several years” to gather that data.
“As challenging as the pandemic was, it also created a crucible in which new ways of delivering cancer care were created,” Kim said. “For example, there was an explosion in telemedicine and alternate treatment methods that shorten duration without compromising quality. Moving forward, continuing to innovate on the delivery of cancer care [could] meaningfully improve outcomes for patients.”
For more information:
Uriel Kim, MD, PhD, MBA, can be reached at uxk13@case.edu.
Collapse
Click Here to Manage Email Alerts