Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors

Abstract

Purpose: While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively.

Methods: This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys.

Results: In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (-74%), new patient E&M visits (-70%), and established patient E&M visits (-60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (-26%) and July (-31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July.

Conclusion: The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.

FIG 1.

Relative change in billing frequencies for select cancer screening procedures (March-July 2019/2020). Billing frequencies were determined by the following procedure codes: breast mammograms (77061, 77062, 77063, 77065, 77066, 77067); colon screening (45330, 81528, 82270, 82272, 82274, G0104, G0105, G0121, G0328); lung screening (31624, G0296, G0297); prostate screening (G0103).

FIG 2.

Relative change in billing frequencies for select physician-administered oncology products (at any site of services) and relative change in chemotherapy administration (by the site of service) (March-July 2019/2020). Billing frequency of the top 23 physician-administered oncology products (and respective biosimilars) as determined by 2018 Medicare Part B spend: Prolia/Xgeva, Neupogen (Zarxio, Nivestym), Somatuline Depot, Aloxi, Neulasta (Fulphila, Udenyca, Ziextenzo), Tecentriq, Bendeka, Avastin (Mvasi, Zirabev), Velcade, Adcetris, Kyprolis, Erbitux, Cyclophosphamide, Darzalex, Yervoy, Abraxane, Keytruda, Opdivo, Alimta, Perjeta, Rituxan (Truxima, Ruxience), Kadcyla, Herceptin (Ontruzant, Hersuma, Ogivri, Trazimera, Kanjinti).

FIG 3.

Relative change in billing frequencies for cancer-related biopsies and surgeries (March-July 2019/2020). Billing frequencies were classified by type of claim and identified by the following procedure codes: chemotherapy injection (96401, 96402, 96405, 96409); chemotherapy infusion (96413, 96415-96417); and chemotherapy administration (96420, 96425).

FIG 4.

Relative change in billing frequencies for cancer-related evaluation and management (E&M) services (March-July 2019/2020). Billing frequencies were determined using a subset of highest-volume procedure codes for each of the following services: breast biopsy (19081-19085); colon biopsy (44389, 45380); lung biopsy (32405, 39402).

FIG 5.

Relative change in billing frequencies for cancer-related evaluation and management (E&M) services by setting of care (March-July 2019/2020). Billing frequencies were determined using a subset of highest-volume procedure codes for each of the following services: mastectomy (19301-19303, 19307); colectomy (44139, 44140, 44143, 44160, 44204, 44205, 44207, 44213); prostatectomy (52601, 52648, 55821, 55840, 55866).

FIG 6.

Total number of claims for cancer-related in-office evaluation and management (E&M) v telehealth E&M services and relative change in billing frequencies (March-July 2019/2020). Billing frequencies were determined by the following procedure codes: new patient E&M (99201-99205); established patient E&M (99211-99215); hospital outpatient (G0463).