COVID-19 disrupts U.S. cancer detection: A two-year review

Cancer detection in the United States was significantly disrupted during the first year of the COVID-19 pandemic, but partially recovered in the second year.

study: Recovering from disruptions in cancer detection related to COVID-19. Image credit: Inside Creative House/Shutterstock.com

In a recent study published in JAMA network open, Using national cancer incidence data from 2000 to 2021, a group of researchers study the disruption and recovery in cancer detection during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. was evaluated.

background

The COVID-19 pandemic has significantly disrupted oncology services, impacting cancer screening, diagnosis, treatment, and survival rates. Cancer incidence fell by nearly 9% in 2020 at the beginning of the pandemic, and by almost 50% during the peak months of lockdown due to reallocation of resources and patients' reluctance to seek treatment. decreased.

Access to cancer diagnostic services was limited, and risk tolerance when seeking care varied by sociodemographic group.

Medical system adapted by expansion telemedicine And prioritize cancer diagnosis. However, the impact on cancer treatment has been dynamic. Further research is needed to assess long-term effects and address gaps in cancer detection during the pandemic.

About research

Study design, analysis, and presentation were conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. The research team clearly explained the study setting, patient participation criteria, and data collection methods.

The statistical methods were designed to be reproducible, and the results were interpreted with caution, recognizing the statistical uncertainties and limitations of the dataset. All analyzes were conducted in May 2024.

The protocol for this cross-sectional study was reviewed and exempted by the Case Western Reserve University Institutional Review Board because it was deemed not to involve human participant research. Informed consent was waived.

Surveillance, Epidemiology, and End Results (SEER) data were used to estimate the percentage difference between predicted and observed cancer incidence in 2020. Expected incidence rates were projected using join point trend modeling based on 20 years of pre-pandemic data (2000-2019). This method was extended through 2021 to assess recovery in cancer detection.

Analyzes were performed combining all cancer types and stratified by demographics, community (county-level) characteristics, and primary cancer site. All incidence rates were age-adjusted and lagged-adjusted when possible. Demographic information includes racial and ethnic variables and is categorized into five mutually exclusive groups.

The observed national deficit in cancer cases was modeled by extrapolating SEER data to national population estimates from the National Cancer Institute and the U.S. Census Bureau. Statistical tests were performed at the α = 0.05 level, and 95% confidence intervals (CI) were calculated using standard methods.

The trend model was selected using a permutation test, and data were accessed via SEER*Stat. Trend analysis was performed using the Joinpoint regression program.

Research results

The study analyzed 15,831,912 patients diagnosed with malignant cancer between January 1, 2000 and December 31, 2021. Using data from patients diagnosed from 2000 to 2019 (n=14,246,457), a trend model was developed to predict expected cancer incidence in 2020 and 2021.

These projections were compared to observed cancer incidence rates during the pandemic year. In 2020 and 2021, 759,810 and 825,645 cases were observed, respectively.

The study included patients with a median age of 65 years (IQR, 56-75 years), with 49.0% female and 51.0% male. Racial and ethnic composition included 0.4% American Indian or Alaska Native, 10.4% Black, 5.0% Asian or Pacific Islander, 11.1% Hispanic, and 72.4% White.

The predicted cancer incidence rate in 2020 was 458.12 per 100,000 population (95% CI, 456.71 to 459.54), while the observed cancer incidence rate was 418.90 per 100,000 population (95% CI, 417.94). ~419.86), which was significantly lower.

This reflects a percentage difference of -8.6% (95% CI, -9.1% to -8.1%) between the expected and observed incidence. By 2021, the observed cancer incidence rate (458.33 per 100,000 people) will closely match the predicted rate of 459.06 people, with a significant difference of -0.2% (95% CI, -0.7% to 0.4%). , showing a recovery in cancer detection rates. .

The estimated national cancer diagnosis shortage in 2020 was 125,167 (95% CI, -131,771 to -118,503), which decreased to 2,764 (95% CI, -11,833 to 6,402) in 2021. The cumulative deficit from 2020 to 2021 was 127,931 cases (95% CI, -139,206 to -116,655).

Subgroup analyzes revealed differential effects of the pandemic on cancer detection by demographic and community characteristics. In 2020, cancer incidence among male patients and patients with localized cancer further decreased.

Furthermore, larger declines were observed in counties with lower poverty rates, higher education levels, and higher proportions of non-U.S.-born residents.

Although incidence rates improved in 2021, cancer detection rates continued to decline among patients living in rural counties (-4.9% in rural counties not adjacent to a metropolitan area; 95% CI, -6.7% to -3.1 %). Conversely, cancer incidence was increased in female patients, patients younger than 20 years of age, and Asian or Pacific Islander populations.

Specific cancer sites were also differentially affected. Gallbladder cancer, eye cancer, and orbital cancer continued to show decreasing incidence in 2021, but lung cancer, bronchial cancer, prostate cancer, melanoma This was the largest cumulative deficit from 2020 to 2021.

Some cancer types, such as gastric and chronic lymphocytic leukemia, have fully recovered and exceeded 2021 expectations.

conclusion

In summary, our analysis shows that after significant disruption in 2020, cancer detection rates improved in 2021, but recovery may vary by patient demographics, community characteristics, and cancer type. Shown. An estimated 127,931 cancer cases went undiagnosed due to the pandemic.

Although most cancer sites had incidence rates closer to baseline by 2021, some cancer sites still had cumulative deficits in diagnosed cases.

To prevent future surges in advanced cases and alleviate disparities in cancer outcomes caused by the pandemic, we must address disparities in undiagnosed cancer, especially in rural and underserved populations. Continuous monitoring is essential.