Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

Abstract

ImportanceEach year, the National Cancer Database (NCDB) collects and analyzes data used in reports to support research, quality measures, and Commission on Cancer program accreditation. Because data models used to generate these reports have been historically stable, year-to-year variances have been attributed to changes within the cancer program rather than data modeling. Cancer submissions in 2020 were anticipated to be significantly different from prior years because of the COVID-19 pandemic. This study involved a validation analysis of the variances in observed to expected 2020 NCDB cancer data in comparison with 2019 and 2018.ObservationsThe NCDB captured a total of 1 223 221 overall cancer cases in 2020, a decrease of 14.4% (Δ = −206 099) compared with 2019. The early months of the COVID-19 pandemic (March-May 2020) coincided with a nadir of cancer cases in April 2020 that did not recover to overall prepandemic levels through the remainder of 2020. In the early months of the COVID-19 pandemic, the proportion of early-stage disease decreased sharply overall, while the proportion of late-stage disease increased. However, differences in observed to expected stage distribution in 2020 varied by primary disease site. Statistically significant differences in the overall observed to expected proportions of race and ethnicity, sex, insurance type, geographic location, education, and income were identified, but consistent patterns were not evident.Conclusions and RelevanceHistorically stable NCDB data models used for research, administrative, and quality improvement purposes were disrupted during the first year of the COVID-19 pandemic. NCDB data users will need to carefully interpret disease- and program-specific findings for years to come to account for pandemic year aberrations when running models that include 2020.

Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US

“…The reductions in treated patients (−16.8%) were high and appeared to exceed reductions in patients with diagnosed cancer (−14.4%), as a total of 155 429 patients in 2020 did not receive any form of treatment. The concern is that such a large number of untreated cancers would result in compromised outcomes for these patients over the next several years, and follow-up studies will be crucial in answering this important question.…”

“…The reduction in the number of patients receiving surgery was nearly double the reductions in patients receiving chemotherapy or radiation, and academic hospitals appeared to be particularly affected. As prior work has demonstrated a lack of stage migration during the pandemic, it is unlikely that the reduction in cancer surgery was attributable to an increase in patients presenting with advanced stage disease. It is tempting to try to extrapolate reductions in provided cancer care to understand the havoc that the pandemic brought to the health care economy .…”

“…This may reflect the overall perception of oncologists at the time—that patients had to be treated quickly before pandemic-related restrictions intensified . Alternatively, this could indicate fewer patients seeking treatment, as fewer patients were diagnosed in 2020 and prior work from the NCDB suggested a 14.4% reduction in newly diagnosed cancer cases . However, most reports citing treatment delays during the first year of the COVID-19 pandemic were from smaller sample populations and may not have been representative of the experience of cancer treatment across the US.…”

“…Although prior work suggests that the data collection infrastructure remained intact, it is important to note that the US was affected in different ways at different times during the pandemic, possibly explaining why anticipated changes were not reflected in these high-level data. Third, interpretation of reductions in cancer treatment must also be done in the context of reductions in cancer diagnoses, of which prior work estimated more than 200 000 fewer cases during the first year of the pandemic …”

“…Previous reports have shown substantial declines in the use of cancer screening in 2020 as well as routine primary care evaluations, which are commonly the inroads to cancer diagnosis . As a result, it has been estimated that 206 099 fewer patients than expected were diagnosed with cancer in 2020 …”