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. 2022 Apr 11;114(4):571-578.
doi: 10.1093/jnci/djab225.

Impact of the COVID-19 Pandemic on Treatment Patterns for Patients With Metastatic Solid Cancer in the United States

Ravi B Parikh  1   2 , Samuel U Takvorian  2 , Daniel Vader  3 , E Paul Wileyto  3 , Amy S Clark  2 , Daniel J Lee  4 , Gaurav Goyal  5 , Gabrielle B Rocque  5 , Efrat Dotan  6 , Daniel M Geynisman  6 , Pooja Phull  6 , Philippe E Spiess  7 , Roger Y Kim  8 , Amy J Davidoff  9 , Cary P Gross  10 , Natalia Neparidze  10 , Rebecca A Miksad  11 , Gregory S Calip  11 , Caleb M Hearn  1 , Will Ferrell  1 , Lawrence N Shulman  2 , Ronac Mamtani  2 , Rebecca A Hubbard  3 ; PRACTICE Investigators
Affiliations

Impact of the COVID-19 Pandemic on Treatment Patterns for Patients With Metastatic Solid Cancer in the United States

Ravi B Parikh et al. J Natl Cancer Inst. .

Abstract

Background: The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic's impact on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metastatic solid cancer.

Methods: We used an electronic health record-derived longitudinal database curated via technology-enabled abstraction to identify 14 136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at approximately 280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on TTI, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy.

Results: The adjusted probability of treatment within 30 days of diagnosis was similar across periods (January-March 2019 = 41.7%, 95% confidence interval [CI] = 32.2% to 51.1%; April-July 2019 = 42.6%, 95% CI = 32.4% to 52.7%; January-March 2020 = 44.5%, 95% CI = 30.4% to 58.6%; April-July 2020 = 46.8%, 95% CI= 34.6% to 59.0%; adjusted percentage-point difference-in-differences = 1.4%, 95% CI = -2.7% to 5.5%). Among 5962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences = 1.6%, 95% CI = -2.6% to 5.8%). There was no meaningful effect modification by cancer type, race, or age.

Conclusions: Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not affect TTI or treatment selection for patients with metastatic solid cancers.

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Figures

Figure 1.
Figure 1.
Changes in the adjusted probability of treatment initiation within 30 days of metastatic diagnosis between COVID-19 and pre–COVID-19 periods. This figure displays the differential effect of the COVID-19 period on the probability of 30-day treatment initiation by cancer type, race, and age (years) among patients with newly diagnosed de novo or recurrent metastatic solid cancer. The error bars represent the 95% confidence intervals. NSCLC = non-small cell lung carcinoma; RCC = renal cell carcinoma; UCC = urothelial cell carcinoma.
Figure 2.
Figure 2.
Changes in the adjusted probability of receiving myelosuppressive therapy after metastatic diagnosis between COVID-19 and pre–COVID-19 periods. This figure displays the differential effect of the COVID-19 period on the probability of receiving myelosuppressive therapy by cancer type, race, and age (years) among patients with newly diagnosed de novo or recurrent metastatic solid cancer. The error bars represent the 95% confidence intervals. NSCLC = non-small cell lung carcinoma; UCC = urothelial cell carcinoma.
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