Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors

Abstract

PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.

Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21–65 Years in a Large Integrated Health Care System — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020

“…Screening rates declined in both routinely screened age groups during the stay-at-home order compared with rates during 2019, with similar declines across all racial and ethnic groups. Rates are compatible with findings of decreased cancer screening rates during 2020 in other parts of the United States ( 1 – 4 ). For example, the electronic health record vendor Epic Systems Corporation reviewed 2.7 million patient records from 39 organizations spanning 23 states and found a 67% decline in mean weekly cervical cancer screening volume during spring 2020, an estimated 40,000 delayed or missed screenings compared with equivalent weeks during spring 2017–2019 ( 1 ).…”

The Fear Returns: Messaging in the Age of Coronavirus Disease 2019 (COVID-19)

“…9 Preventative screenings for cervical, breast, and colon cancer plummeted. [10][11][12] And radiation oncology clinics in the United States reported treating 32% fewer patients than normal in April. 13 Given the risks of delaying cancer treatment, these trends were especially concerning.…”

Management of lung cancer in the COVID-19 pandemic: a review

“…According to a recent study that used a large medical claim database in the United States [55] , cancer-related procedures (screening, biopsies, therapy) significantly dropped during the year 2020 when compared to the previous year 2019. Specifically, lung biopsies dropped by 58% and 47% during April 2020 and July 2020, respectively; lung cancer screening dropped by 75% in April 2020 and outpatient visits dropped by 74% in April 2020.…”