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According to researchers, there was a 14.4% decrease in newly reported cancer diagnoses in 2020 compared to previous years, which appears to be associated with the implementation of stay-at-home orders during the initial months of the COVID-19 pandemic.
Based on an analysis of reported cases of new cancer diagnoses in the National Cancer Database (NCDB), a study has estimated that approximately 200,000 individuals with cancer may not have been diagnosed or treated at Commission on Cancer-accredited facilities at the beginning of the COVID-19 pandemic in 2020. This coincides with the implementation of triage guidelines that recommended delays in cancer-related care during the same time period.
The lead author of the study noted that the analysis revealed a consistent trend of declining cancer cases starting in March 2020, with the lowest point observed in April, and only a partial recovery during the mid-year. However, there was no rebound observed in terms of backlogged cases or a return to the levels of cancer cases seen in previous years.
Dr. Sharon Lum, Chair of the Loma Linda University Health Department of Surgery and the principal investigator of the study, expressed that their findings confirmed their fears that a significant number of cancer cases were not diagnosed or treated during the early months of the pandemic and did not catch up in the first year. This implies that there may be a group of "missing cases" that are yet to be diagnosed or treated, and there is a concern that these patients may present later with more advanced stages of the disease.
The study was recently published in the Journal of the American Medical Association Surgery, and the authors aim for their findings to serve as a valuable reference for researchers, quality reports, and process improvement projects that utilize data from the National Cancer Database (NCDB). The study's findings provide insights into the impact of the COVID-19 pandemic on cancer diagnoses and may contribute to enhancing the accuracy and validity of future studies and projects that rely on NCDB data.
Dr. Lum emphasized that researchers using NCDB data from 2020 should be aware that the reported cases have been significantly impacted by the disruptions caused by the pandemic. The NCDB, which is a collaboration between the American College of Surgeons Commission on Cancer and the American Cancer Society, is one of the world's largest cancer registries, representing over 70% of all cancer cases in the United States. It is utilized by nearly 1,500 Commission on Cancer-accredited programs, including Loma Linda University Health, to enhance the quality of cancer care in the United States. Dr. Lum has previously served as the vice-chair of the Commission on Cancer's quality integration committee.
Year-over-year since 1989, NCDB data have proven historically reliably stable, Lum says. Yet “the COVID-19 pandemic destabilized usual patterns of cancer care,” study authors wrote.
Dr. Lum highlighted that historically, year-over-year data from NCDB since 1989 have been consistently stable. However, the COVID-19 pandemic has disrupted the usual patterns of cancer care, as noted by the study authors. The impact of the pandemic on cancer diagnoses and treatments has led to deviations from the typical trends observed in NCDB data, highlighting the need for caution and consideration when interpreting and utilizing cancer data from 2020 in comparison to previous years.
Additionally, Lum says researchers observed less than expected numbers of early-stage diseases in the pandemic’s early months and simultaneously observed more than expected cases of late-stage diseases.
Researchers did not identify any overall patterns in patient demographics to account for the varied differences of observed-to-expected proportions of reported cancer cases, Lum says.
“The differences in expected versus observed cases didn’t happen in the same way across the board for every single cancer site,” Lum says. “There were high levels of variation between different diseases and individual cancer sites.”
Dr. Lum highlighted that the study's findings provide a valuable month-by-month breakdown of the trends in reported cancer cases in the NCDB during 2020, which is not standardly available to NCDB users. These insights offer important details on the progression of cancer cases during the pandemic year. The authors of the study recommend that NCDB users engaged in cancer care quality reporting, process improvement, or research exercise caution when interpreting disease- and program-specific results for 2020 and subsequent years, taking into account the disrupted data from the pandemic year. They also recommend conducting validation studies to verify the accuracy of the 2020 data and including disclaimer language in publications that utilize 2020 NCDB data. This underscores the importance of careful and thoughtful use of data in light of the unique circumstances and challenges posed by the COVID-19 pandemic.
“We are alerting the cancer community to look carefully at their institutional data to see how what happened in 2020 could have affected what their reports looked like,” Lum said. “Database users should consider what activities took place in their local and institutional environment that first year of the pandemic.”
Dr. Lum highlighted that the downstream effects of the 2020 data set, including impacts on longitudinal survival reports, are not yet fully understood. The Commission on Cancer plans to continue monitoring the 2020 NCDB cohort and conducting validity studies with subsequent data cohorts in 2021 and 2022 to further assess the implications of the pandemic on cancer care. Future research could also investigate associations between COVID-19 infection, treatment adherence, outcomes, and long-term follow-up of the 14.4% of cancer diagnoses that were not treated as expected in Commission on Cancer-accredited cancer programs. This ongoing research will help to better understand the long-term effects of the pandemic on cancer care and inform strategies for improving cancer outcomes in the future.
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