The results of COVID-19 are as follows: Lung cancer prevention screening goes down and patient outcomes worsen

The news may not come as a surprise, but a study published today confirms that many providers in the industry were afraid of what would happen during a pandemic. Decreased lung cancer screening due to service cancellation or postponement exacerbated patient outcomes.

Since the beginning of the pandemic, cross-sectional analysis has revealed a 46% plunge in new cancer diagnoses nationwide across six common cancer forms, including lung cancer. In a study published on December 17th Journal of American Universities of Surgeons, A team of researchers led by Dr. Robert Van Harlen, MD, a thoracic surgeon and assistant professor of surgery at the University of Cincinnati, focused on the impact of not being able to provide low-dose CT (LDCT) screening to patients at risk during this time. did. time.

They found that the decline in screening was beyond the early stages of the pandemic.

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“When low-dose radiation CT scans were stopped on March 13, 2020, 818 screening visits were cancelled. [in our institution]”Van Halen said. “It gradually resumed on May 5th and was fully resumed on June 1st. During the COVID-19 period analyzed, the sum of monthly CT scans and new patient monthly scans decreased significantly. Full operation will resume. “

His team retroactively analyzed screening rates and conducted baseline LDCT screening in hospitals from January 2017 to February 2020, in the early stages of the pandemic, from March 2020 to July 2020. Compared to the one completed on the day. Patients included in the study were 55 to 80 years old, and they smoked 1 pack daily for 30 years or 2 packs daily for 15 years. All patients also underwent initial lung cancer screening.

Overall, the team found that the total monthly screening, from pre-COVID to COVID, and the screening of new patients decreased from 146 to 39 and 56 to 15, respectively.

In addition, the screening “no-show” rate has increased from 15% to 40%. According to the team, most of these absentee appointments (112 out of 139 during the pandemic) were annual tests, and patients who skipped scans tended to be younger and were smokers of African-American women. was. It is feared that this group will forgo screening.

“This aspect of lung cancer screening can exacerbate existing disparities in lung cancer survival and needs further study,” they said. “African Americans already have poor overall survival and are unlikely to undergo curative lung resection.”

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However, the most feared effect of reduced screening during the pandemic era was a significant increase in Van Haren’s team identified in patients with potentially cancerous lung nodules (Lungs-RADS4). The detection rate of these nodules increased from 8 percent to 29 percent after screening was resumed.

“After the screening surgery was resumed, an increase in lung nodules suspected of being malignant was observed,” the team said. “Patients are more likely to be referred to the tumor board to enlarge the nodule, and referrals for intervention have increased significantly among tumor board patients during COVID-19.”

Van Halen said these cancers could have been detected and treated earlier if regular LDCT screening proceeded normally during the pandemic month. A backlog of screening confirmations and reschedules still exists.

Reportedly, 13% of cancer patients with COVID-19 die of lung cancer patients facing specific risks from smoking prevalence and underlying lung disease, thus risking these patients. It is important to mitigate. In fact, existing studies show that 76% of patients with thoracic malignancies and COVID-19 are ultimately hospitalized and 33% die. According to UK data, the increase in lung cancer mortality due to delayed diagnosis during the pandemic era was 4.8% to 5.3%.

This lack of rebound is important at various levels. Similar screening declines were seen for breast and colon cancer, but this decline indicates disastrous potential, as LDCT utilization is already very low, at about 4.5% of eligible patients. I will.

“The national utilization of LDCT is low at baseline, so further reductions have a potential negative impact on both cancer-related mortality and future use of lung cancer screening.”

The findings unearthed by Van Harlen’s team said the findings unearthed by Michigan’s healthcare provider William Weir, MD, and Chest Surgery, Andrew C. Chan, MD, were very important. The effects of COVID-19 on other health conditions are known.

“The long-term effects of this year’s closure are just beginning to emerge,” they wrote in an accompanying commentary. “Until they are fully known, we will promptly resume screening operations, increase access to the community to emphasize the safety of patients in preventive care, and limit or cancel diagnostic procedures. We strongly recommend that you take great care. “

Van Haren agreed, arguing that the study, and using his team’s screening program as a model, provided an early analysis of pandemic-related outcomes.

“Our results provide a framework for future decisions in the ongoing COVID-19 pandemic,” said Van Halen. “Lung cancer screening surgery should be prioritized and continued to prevent adverse effects such as delayed diagnosis that can lead to increased cancer-specific mortality.”

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