Substantial Declines in Diagnosis and Treatment of Cancers Observed Due to COVID-19 Pandemic

An examination of population-based Surveillance, Epidemiology, and End Results registries in Georgia and Louisiana from 2019 to 2020 determined that the diagnosis and treatment of various cancers were delayed due to the COVID-19 pandemic.

Substantial delays in both diagnoses and treatment services for patients with cancer during the COVID-19 pandemic were reported by investigators, according to findings from a study published in the Journal of the National Cancer Institute.1

Overall, there were a total of 29,905 fewer pathology reports from 2020 vs 2019, translating to a 10.2% decrease in reports (95% CI, 10.2%-10.2%). Declines were observed across all patient age groups, including children and adolescents under the age of 18 years.

“We observed substantial declines in 2020 among cancers with effective screening tests, including breast and colorectal cancers, as well as across cancer sites and age groups without effective screening tests, including cancers among children and young adults,” Robin Yabroff, PhD, MBA, scientific vice president of health services research at the American Cancer Society, said in a press release.2 “Declines across cancer sites and age groups suggest that in addition to delays in cancer screening, there were also delays in routine well-child and primary care, evaluation of signs and symptoms, and treatment initiation for most cancers.”

Pathology report data were collected from 2 population-based Surveillance, Epidemiology, and End Results (SEER) registries, specifically those of Georgia and Louisiana. The reports were organized biweekly via specimen collection date for every age group and cancer site.

Each report provided the date of specimen collection, as well as each patient’s birth date. Reports and data collected for 2019 were similar to that of 2018, suggesting that 2019 was not an unusual year compared to historical trends.

Declines in pathology reports were the highest among patients who were 50 years or older (n = 23,065), and patients under the age of 18 years experienced the greatest percentage declines (38.3%; 95% CI, 38.3%-38.9%). In terms of declines by disease type, the highest absolute declines were observed in patients with breast cancer (n = 5947) and lung cancer (n = 5844). Moreover, the highest percentage declines were observed in those with lung cancer (17.4%; 95% CI, (17.4%-17.5%) and colorectal cancer (12.0%; 95% CI, 11.9%-12.0%).

The biweekly data from pathology reports biweekly demonstrated similarities between January 2020 and early March 2020, although findings were occasionally higher than the same period in 2019. The nadir was observed in April 2020, with investigators reporting a decline in reports of 42.8% compared with April 2019. Declines appeared to occur with the peaks in biweekly mortality rates. Overall, the number of reports through December 2020 never “consistently exceeded” trends observed after the initial declines in April 2019. Moreover, biweekly patterns of pathology reports in both 2020 and 2019 appeared to be similar by disease site, although there was a degree of variation in timing magnitude, and duration of decline.

The research cited limitations, specifically focusing on the fact that data came from only 2 states. Additionally, the information gathered focuses on pathology reports and not cancer diagnoses. The number of reports per case could vary by site in terms of historical data, according to the investigators.

“The findings suggest substantial delays in diagnosis and treatment services for cancers during the pandemic, and that ongoing evaluation can inform public health efforts to minimize any lasting adverse effects of the pandemic on cancer diagnosis, stage, treatment, and survival. As data become available, evaluation of the effects of the pandemic on cancer stage at diagnosis and survival will be important, as will evaluation of racial/ethnic, socioeconomic, and geographic disparities in access to care and outcomes,” the investigators concluded.

References

  1. Yabroff KR, Wu XC, Negoita S, et al. Association of the COVID-19 pandemic with patterns of statewide cancer services. J Natl Cancer Inst. Published online, June 28, 2021. doi:10.1093/jnci/djab122
  2. Study finds adverse effects of COVID-19 pandemic on cancer detection and surgical treatments. News release. American Cancer Society. June 28, 2021. Accessed September 15, 2021. https://bit.ly/3EozvwO