ONCE SHELTER-IN-PLACE ORDERS WERE ENACTED IN MARCH because of the COVID-19 pandemic, the number of new diagnoses of cancer declined sharply in the United States. Newly-published data confirms this fact.
The data also support the warnings of anatomic pathologists that—because of the pandemic and shelter-in-place directives—fewer patients visited physicians’ offices, meaning many cases of cancer and other conditions could go undiagnosed.
In new data published earlier this month in JAMA Network Open, researchers from Quest Diagnostics reported on the decline in new diagnoses for six common cancers: breast, colorectal, esophageal, gastric, lung, and pancreatic cancer.
Beginning March 1 and extending through the end of the month when the decline leveled off, the number of diagnoses declined by more than 46% for the six cancers, the researchers wrote. The study, “Changes in the Number of US Patients with Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic,” was published online on Aug. 4.
During the pandemic, the weekly number fell 46.4% (from 4,310 to 2,310) for the six cancers combined, ranging from 24.7% for pancreatic cancer (from 271 to 204) to 51.8% for breast cancer (from 2,208 to 1,064), researchers wrote.
In an interview with The Dark Report, the study’s lead author, Harvey W. Kaufman, MD, Quest’s Senior Medical Director, said the data are significant by themselves and serve as a proxy for other diagnostic work AP groups and clinical labs have done during the pandemic.
Pent-up Demand for Care
“As much as our research applies to cancer—as it should because cancer carries more weight than other medical conditions—the message from this work applies to everything else in healthcare,” he said. “It certainly applies to dental care, for example, but it also applies to lipid screens, diabetes screens, chronic kidney disease, and other conditions.
“It applies to all other diagnoses because during the lockdown people were told not to go for routine care,” added Kaufman. “Doctors’ offices were closed and there was little normal care in emergency rooms.”
Other healthcare experts have said that the months of shelter-in-place directives created pent-up demand for care that will result in increased testing volume when those patients return to visiting doctors’ offices for screening tests and other diagnostic work.
“That means everyone in healthcare needs to re-engage so that we can capture what was missed,” Kaufman commented. Some patients have returned to get care they missed, he added. “Our volume has bounced back, although not totally. In particular, it has not come back in Florida,” he explained. “But overall, we’ve had an excellent return of testing volume as more doctors’ offices opened and more patients see doctors and get screened for cancer.
“It’s comforting that more patients are getting screened, but there’s still a gap between what we had for test volume last year and what we see now because not everyone has returned,” Kaufman noted. “Clearly, people are concerned about going out in public, about traveling, and about going into healthcare facilities where there are other patients.
Patients Still Have Concerns
“Patients are concerned about going to doctors’ waiting rooms where there are likely to be patients who are asymptomatic or symptomatic with COVID-19,” Kaufman commented.
What does a decline in cancer screening visits mean for patients? The researchers answered that question, writing, “While residents have taken to social distancing, cancer does not pause.” Therefore, the delay in diagnosis could cause patients to visit physicians at more advanced stages of disease, leading to poorer outcomes and death. “One study suggests a potential increase of 33,890 excessive cancer deaths in the United States,” the researchers wrote.
“To put that number in perspective, an estimated 34,000 excess cancer deaths would be 5% to 6% over and above the projected 600,000 deaths from cancer last year,” Kaufman commented. “That’s not on the same scale of more than 170,000 excess deaths from COVID-19, but it’s a real number, and every life is significant.”
Possible Surge in Demand
For lab directors and anatomic pathologists, the researchers suggested the data could indicate a need to plan for how to address a surge in demand for testing. Urgent planning to address the consequences of delayed diagnoses may include a wider use of telehealth screening and more tools to allow patients to schedule screening visits with clinical specialists, the researchers wrote.
Weekly Data Show Declines in All Cancer
For a study published in JAMA Network Open on Aug. 4, researchers analyzed weekly changes in the number of patients with newly-identified cancer before and during the COVID-19 pandemic. The researchers included U.S. patients whom Quest Diagnostics tested for any cause and whose ordering physicians assigned them an ICD-10 code associated with breast, colorectal, esophageal, gastric, lung, and pancreatic cancer from Jan. 1, 2018, to April 18, 2020.
The mean weekly numbers of patients newly diagnosed during the baseline period of Jan. 6 through Feb. 29, 2020, were compared with the mean weekly number of patients diagnosed during the COVID-19 period of March 1 to April 18, 2020. In the study, 258,598, or 92.8%, of the patients were from the baseline period, and 20,180, or 7.8%, from the COVID-19 period.
In the baseline period, the mean weekly number of newly-identified patients showed 2,208 were diagnosed with breast cancer, 946 had colorectal cancer, 695 with lung cancer, 271 with pancreatic cancer, 96 with gastric cancer, and 94 with esophageal cancer.
During the pandemic, the researchers found significant declines in all cancer types. “The decrease had generally leveled beginning the week starting March 29, 2020,” they added. The Quest findings are similar to that of researchers from other countries.
The lead author of the study was Harvey Kaufman, MD, Quest’s Senior Medical Director. His colleagues from Quest were Yuri Fesko, MD, Medical Director of Oncology, and Senior Health Informatics Analysts Zhen Chen, MS, and Justin Niles, MA.
Contact Harvey Kaufman, MD, at 201-213-8452; firstname.lastname@example.org.