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CME / ABIM MOC / CE

What Impact Has the COVID-19 Pandemic Had on Cancer Screenings and Diagnosis?

  • Authors: News Author: Donavyn Coffey; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 1/7/2022
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/7/2023
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Target Audience and Goal Statement

This activity is intended for all primary care physicians, oncologists, nurses, pharmacists, and other members of the healthcare team who care for patients at risk for cancer.

The goal of this activity is to assess the impact of the COVID-19 pandemic on healthcare visits related to cancer.

Upon completion of this activity, participants will:

  • Analyze a previous study of cancer screening practices during the COVID-19 pandemic
  • Assess how the COVID-19 pandemic affected cancer-related healthcare visits and screening for patients using Veterans Affairs services in 2020
  • Outline implications for the healthcare team


News Author

  • Donavyn Coffey

    Freelance writer, Medscape

    Disclosures

    Disclosure: Donavyn Coffey has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CME Reviewer

  • Esther Nyarko, PharmD

    Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

Mitigation

All of the relevant financial relationships listed for these individuals have been mitigated.


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CME / ABIM MOC / CE

What Impact Has the COVID-19 Pandemic Had on Cancer Screenings and Diagnosis?

Authors: News Author: Donavyn Coffey; CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC / CE Released: 1/7/2022

Valid for credit through: 1/7/2023

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The COVID-19 pandemic has had profound societal effects, including how health care is practiced. Many routine healthcare services were negatively affected by the pandemic. A previous study by McBain and colleagues, which was published in the June 2021 issue of the Journal of General Internal Medicine,[1] used data from a large US commercial health insurance database to assess rates of mammography and colonoscopy from January 15, 2020 to March 13, 2020 with rates from March 14, 2020 to July 31, 2020. The US government declared a national emergency because of COVID-19 on March 13, 2020.

Researchers found that the respective total decreases in the median weekly rates of mammography and colonoscopy in comparing the prepandemic and postpandemic periods were 96% and 95%. By the end of July, rates of mammography and colonoscopy had rebounded moderately but not to prepandemic levels. The decline in colonoscopy screenings was most profound in counties with a higher mean income.

The current study by Englum and colleagues provides a more comprehensive view of cancer-related visits, examining screening procedures and new diagnoses of cancer across 2020.

Study Synopsis and Perspective

The COVID-19 pandemic has led to substantial declines in cancer screenings and new cancer diagnoses, according to a large analysis published on December 6 in Cancer.[2]

Mining data from more than 9 million US veterans, researchers reported a 13% to 23% drop in diagnoses of prostate, lung, bladder, and colorectal cancers in 2020 compared with 2018 and 2019. The most significant dip occurred in the early days of the pandemic, when COVID-19 surges and lockdowns across the US delayed cancer screenings and care, but the backlog continued to accumulate through the end of 2020, according to the study's lead author, Brajesh Lal, MD, director of the Center for Vascular Research at the University of Maryland, in College Park, Maryland.

Early on, "all of us were so focused on the impact of the [COVID-19] surge, infection, and deaths resulting from it that naturally and appropriately we marshalled all our resources to attack that," Lal told Medscape Medical News. "What surprised me was the extent to which the reduction in these health services persisted well beyond the acute surge. We have still not recovered."

Lal and colleagues embarked on the current study to better understand how the pandemic affected cancer screenings and diagnostic procedures, and consequently new cancer diagnoses, by examining data from millions of patients in the Veterans Health Administration: the largest integrative dataset in the United States.

Using 2018 and 2019 cancer-related healthcare encounters, cancer screenings, and diagnoses as a baseline, the researchers calculated pandemic-fueled changes in diagnostic and screening procedures as well as new diagnoses of prostate, lung, bladder, and colorectal cancers in 2020.

Lal and colleagues found that colonoscopies decreased the most, by 45%; however, diagnostic and screening procedures in the other 3 categories also experienced a big decline: Prostate biopsies dropped by 29%, cystoscopies for bladder cancer by 21%, and chest computed tomography (CT) scans for lung cancers by 12%.

These deficits varied by location, although "no consistent pattern by geographic region or state size" emerged, the authors noted. For instance, two-thirds of states demonstrated declines in prostate biopsies greater than 25% in 2020 compared with 2018 and 2019, and just over one-third of states showed a similar decline in cystoscopies.

New cancer diagnoses also dropped significantly in 2020, with the largest decrease occurring in the first few months of the pandemic. For instance, between March and May, prostate cancer diagnoses fell by more than 50%. The authors observed "similar proportional decreases" in new colorectal, lung, and bladder cancer diagnoses.

Although new cancer diagnoses began to pick up starting in June 2020, they never reached prepandemic levels.

"As a result, the deficit of new cancer diagnoses continued to accumulate throughout 2020," the authors wrote.

Overall, the researchers estimated a 23% decline in new prostate cancer diagnoses, 20% for colorectal cancer, 18% for bladder cancer, and 13% for lung cancer throughout 2020 compared with 2018 and 2019.

The authors highlighted several reasons why diagnoses did not rebound, including pandemic-related financial hardships, perceived risks for invasive procedures such as colonoscopies, and patients falling out of their healthcare routine. Lal also noted that resource shortages caused by the pandemic, including nursing shortages and hospital closures, may have also prevented a return to normal.

Lal pointed to several limitations of using the Veterans Affairs (VA) database. For one, the data are exclusive to veterans, who are predominantly older White men. The VA population also has fewer healthcare-related financial pressures than non-VA patients, so it is possible the findings would be worse for non-VA patients.

Next, the research team plans to analyze the impact of these delays on patients' long-term health.

Several reports have already begun to highlight the consequences of delayed cancer diagnoses.[3] For instance, a survey from the American Society for Radiation Oncology,[4] published in March 2021, found that two-thirds of physicians reported diagnosing more severe disease in new patients in early 2021 vs before the pandemic.

"We are going to be seeing the impact of the pandemic 2, 5, 10 years down the road because of how it impacted early diagnosis of cancer," Lal told Medscape Medical News.

The study was supported by a grant from the Department of Veterans Affairs. Lal reported receiving grants from the Department of Veterans Affairs and the National Institutes of Health.

Study Highlights

  • The study period extended from January 1, 2018 to December 31, 2020 and included a national sample of patients receiving care at VA facilities in the United States.
  • Patients included in the study had a clinical encounter for cancers of interest, which included prostate, lung, bladder, and colorectal cancer. These visits could include a screening or diagnostic test for one of these cancers or a new diagnosis of a cancer of interest. All pertinent visits were determined from diagnosis and procedure codes.
  • The main study analysis compared the rates of cancer-related health visits in the prepandemic period, January 1, 2018 to December 31, 2019, with rates during the pandemic period, January 1, 2020 to December 31, 2020.
  • There were 4.1 million cancer-related encounters during the prepandemic period, including 3.9 million relevant diagnostic and screening procedures. Nearly 140,000 new prostate cancers were diagnosed in the prepandemic period, as well as 51,224 cases of lung cancer, 27,697 cases of colorectal cancer, and 32,766 cases of bladder cancer.
  • The median age of patients undergoing diagnostic or screening tests for cancer was 67 years, and 92% were male. The median age of patients was similar in the prepandemic and pandemic periods.
  • There was little change in the rate of cancer-related health visits in comparing the prepandemic and early pandemic periods for lung, bladder, and colorectal cancer; however, the rate of visits for prostate cancer declined by 26%. Encounters for prostate cancer rebounded to near baseline levels by summer 2020.
  • Encounters for active cancers of the lung, bladder, and colorectum declined by 10%, 27%, and 19%, respectively, between the prepandemic period and April 2020.
  • Screening was even more profoundly affected by the pandemic, with decreased rates of prostate biopsies (80%), chest CT (64%), cystoscopies (74%), colonoscopies (93%), and fecal occult blood tests (54%).
  • In contrast to clinical cancer encounters, rates of cancer screening tests did not rebound for the duration of 2020.
  • There was no discernible geographic pattern to the disruption of cancer care services in 2020.
  • An estimated 11,362 fewer cases of prostate cancer were diagnosed during 2020 compared with the baseline years 2018 and 2019. The respective decreases for lung, bladder, and colorectal cancers were 2365, 2130, and 1979, respectively.

Clinical Implications

  • A previous study by McBain and colleagues found that the median weekly rates of mammography and colonoscopy declined by 96% and 95% in comparing the pre--COVID-19 pandemic period with a postpandemic period through July 2020. There was a moderate rebound of these screening procedures by July 2020 but not to prepandemic levels.
  • In the current study by Englum and colleagues, rates of healthcare visits for prostate cancer were lower in the COVID-19 pandemic period compared with the prepandemic period; however, visits for bladder, lung, and colorectal cancer were not affected. Screening tests for all of these types of cancer declined during the pandemic.
  • Implications for the healthcare team: The healthcare team should continue to emphasize routine cancer screening among eligible patients, regardless of the COVID-19 pandemic.

 

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