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. 2021 Sep;10(18):6327-6335.
doi: 10.1002/cam4.4183. Epub 2021 Aug 6.

Trends in cancer imaging by indication, care setting, and hospital type during the COVID-19 pandemic and recovery at four hospitals in Massachusetts

Ottavia Zattra  1   2   3 , Anthony Fraga  1   2   3 , Nancy Lu  1   2   3 , Michael S Gee  1   2   3 , Raymond W Liu  1   2   3 , Michael H Lev  1   2   3 , James A Brink  1   2   3 , Sanjay Saini  1   2   3 , Min Lang  1   2   3 , Marc D Succi  1   2   3
Affiliations

Trends in cancer imaging by indication, care setting, and hospital type during the COVID-19 pandemic and recovery at four hospitals in Massachusetts

Ottavia Zattra et al. Cancer Med. 2021 Sep.

Abstract

Background: We aimed to investigate the effects of COVID-19 on computed tomography (CT) imaging of cancer.

Methods: Cancer-related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre-COVID-19 (1/5/20-3/14/20), COVID-19 peak (3/15/20-5/2/20), and post-COVID-19 peak (5/3/20-11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non-urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university-affiliated community hospital (UACH), and sole community hospitals (SCHs).

Results: During the COVID-19 peak, a significant drop in CT volumes was observed (-42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively (p < 0.0001). In the post-COVID-19 peak period, cancer screening and initial workup CTs did not recover (-11.7%, p = 0.037; -20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline (p = 0.022) and the UACH a 41.5% increase (p < 0.001). Outpatient CTs recovered after the COVID-19 peak, but with a shift in utilization away from the QAC (-8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED-based oncologic CTs increased post-peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively).

Conclusions: Cancer imaging was severely impacted during the COVID-19 pandemic. CTs for cancer screening and initial workup did not recover to pre-COVID-19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.

Keywords: COVID-19 pandemic; X-ray computed; cancer; imaging; medical; neoplasms; tomography.

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Conflict of interest statement

The authors declare no relevant conflict of interest.

Figures

FIGURE 1
FIGURE 1
Data analysis algorithm
FIGURE 2
FIGURE 2
Weekly volumes of all computed tomography (CTs) and oncologic CTs from 5 January 2020 to 14 November 2020
FIGURE 3
FIGURE 3
Weekly Average computed tomography volumes by imaging indication across the three study periods
See this image and copyright information in PMC

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