Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

Abstract

Background We aimed to investigate the effects of COVID‐19 on computed tomography (CT) imaging of cancer. Methods Cancer‐related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre‐COVID‐19 (1/5/20–3/14/20), COVID‐19 peak (3/15/20–5/2/20), and post‐COVID‐19 peak (5/3/20–11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non‐urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university‐affiliated community hospital (UACH), and sole community hospitals (SCHs). Results During the COVID‐19 peak, a significant drop in CT volumes was observed (−42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively ( p < 0.0001). In the post‐COVID‐19 peak period, cancer screening and initial workup CTs did not recover (−11.7%, p = 0.037; −20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline ( p = 0.022) and the UACH a 41.5% increase ( p < 0.001). Outpatient CTs recovered after the COVID‐19 peak, but with a shift in utilization away from the QAC (−8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED‐based oncologic CTs increased post‐peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively). Conclusions Cancer imaging was severely impacted during the COVID‐19 pandemic. CTs for cancer screening and initial workup did not recover to pre‐COVID‐19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.

Impact of the COVID‐19 pandemic on rural and urban cancer patients' experiences, health behaviors, and perceptions

“…40 Nonurgent imaging services that were considered general elective screening appointments, particularly lung and breast screenings, were also impacted, 41 with cancer surveillance and diagnostic services dropping by more than 50%. 39 The observed changes in surgery and imaging utilization between our rural and urban patients likely reflect the impact of facility closures, reduced lung and breast imaging capacity at facilities, travel barriers, combined with patients’ willingness to go to medical clinics as well as access to medical care (eg, loss of health insurance). For instance, rural patients in our study were significantly older than urban patients, which may have led to rural patients avoiding hospitals for fear of contracting COVID‐19 as elderly individuals are more susceptible to having severe disease.…”

“…We observed that rural versus urban patients were more likely to be older, not employed, uninsured, and have unhealthy behaviors (eg, smoking), consistent with prior research. 35 36 and imaging services [37][38][39] were delayed or cancelled during the initial phase of the COVID-9 pandemic. Nearly all states, including Utah, issued emergency executive orders postponing elective surgeries and medical procedures between March and April 2020.…”

“…Nearly all states, including Utah, issued emergency executive orders postponing elective surgeries and medical procedures between March and April 2020 40 . Nonurgent imaging services that were considered general elective screening appointments, particularly lung and breast screenings, were also impacted, 41 with cancer surveillance and diagnostic services dropping by more than 50% 39 . The observed changes in surgery and imaging utilization between our rural and urban patients likely reflect the impact of facility closures, reduced lung and breast imaging capacity at facilities, travel barriers, combined with patients’ willingness to go to medical clinics as well as access to medical care (eg, loss of health insurance).…”

Impact of COVID-19 on cancer screening: a global perspective

“…In studies conducted in Canada, the United States, Brazil, France, Qatar, Taiwan, and Belgium, COVID-19 had a dramatic impact on mammography and/or MRI of the breast (À10 to À100%) [11, 14,15,16 ,34-37,40,43,44,46]. A significant drop in cancer screening computed tomography imaging in the United States (À49 to À81.7%) [32,37] ], and oral cancer in Taiwan (À50%) [43]. Cancer screening rates were impacted according to the prevalence of COVID-19 in the respective countries, poorly controlled COVID-19 infection rates, or the preparedness of the healthcare systems in dealing with crises such as the pandemic.…”

“…In studies conducted in Canada, the United States, Brazil, France, Qatar, Taiwan, and Belgium, COVID-19 had a dramatic impact on mammography and/or MRI of the breast (−10 to −100%) [ 11 , 14 , 15 , 16 ▪ , 19 ▪ , 21 ▪ , 22 ▪ , 25 , 28 , 30 ▪▪ , 34 – 37 , 40 , 43 , 44 , 46 ]. A significant drop in cancer screening computed tomography imaging in the United States (−49 to −81.7%) [ 32 , 37 ] and diagnostic radiology rates (−16%) was observed in Switzerland [ 17 ]. Reductions in cancer screening were reported for cervical cancer (−7.5 to −90%) in Canada, the United States, Brazil, France, Taiwan, Belgium, and 17 selected low- and middle-income countries (LMICs) [ 19 ▪ , 21 ▪ – 23 ▪ , 30 ▪▪ , 33 , 35 ▪ , 36 , 38 – 40 , 43 , 46 ].…”