Evolving Effect of the COVID-19 Pandemic on Cancer-Related Encounters

Abstract

Purpose: This is an update to a previously published report characterizing the impact that efforts to control the COVID-19 pandemic have had on the normal course of cancer-related encounters.

Methods: Data were analyzed from 22 US health care organizations (members of the TriNetX global network) having relevant, up-to-date encounter data. Although the original study compared encounter data pre-COVID-19 (January-April 2019) with the corresponding months in 2020, this update considers data through April 2021. As before, cohorts were generated for all neoplasm patients (malignant, benign, in situ, and of unspecified behavior), all new incidence neoplasm patients, exclusively malignant neoplasm patients, and new incidence malignant neoplasm patients. Data on the initial cancer stage were available for calendar year 2020 from about one third of the study's organizations.

Results: Although COVID-19 cases fluctuated through 2021, newly diagnosed cancers closely paralleled the prepandemic base year 2019. Similarly, screening for breast, colorectal, and cervical cancers quickly recovered beginning in May 2020 to prepandemic numbers. Preliminary data for the initial cancer stage showed no significant difference (P > .10) in distribution for breast or colon cancers between 2019 and 2020.

Conclusion: Although the number of COVID-19 cases fluctuated, the steep declines observed during March and April 2020 in screening for breast and colon cancer and patients with newly diagnosed cancer did not continue through the rest of 2020 and into April 2021. Screening and new incidence cancer numbers quickly rose compared with prepandemic levels. The concern that more patients with advanced-stage cancer would be seen in the months following the drastic dips of March-April 2020 was not realized as the major disruption to normal cancer care was limited to these 2 months.

FIG 1.

The COVID-19 cancer research network descriptive statistics and demographics: (A) distribution of patient age, sex, and race/ethnicity within the network and (B) geographic distribution split into Northeast, Midwest, South, and West regions. Network statistics represent the distribution in sizes of individual institutions included in the network.

FIG 2.

The effects of the COVID-19 pandemic on new incidence patient encounters. (A) New incidence encounters associated with any neoplasm (ie, no previous encounter related to the indicated neoplasm diagnosis). Patients from both 2020 and 2021 compared with 2019 numbers, with the black line representing the percent change as compared with 2019. (B) Plot of patients with new incidence cancer in 2020/2021 compared with 2019 (left ordinate, top two curves) and COVID-19 cases at these institutions superimposed (right ordinate, bottom teal curve).

FIG 3.

The effects of the COVID-19 pandemic on patients with new incidence encounters associated with malignant neoplasms. (A) With malignant neoplasms (new incidence) defined as no previous encounter related to the indicated diagnosis, patients from both 2020 and 2021 compared with the number of patients in 2019. The black line represents the percent change as compared with 2019. (B) Plot of patients with new incidence malignant cancer in 2020/2021 compared with 2019 (left ordinate, top two curves) and COVID-19 cases at these institutions superimposed (right ordinate, bottom teal curve).

FIG 4.

The effects of the COVID-19 pandemic on breast cancer (mammogram), colorectal cancer, and cervical cancer screening. Percent change from the prepandemic year 2019 to 2020-2021 is shown for the indicated 2-week intervals.