Comparative Study
doi: 10.1200/CCI.20.00068. Effects of the COVID-19 Pandemic on Cancer-Related Patient EncountersAffiliations
AffiliationsItem in Clipboard
Comparative Study
Effects of the COVID-19 Pandemic on Cancer-Related Patient EncountersJack W London et al. JCO Clin Cancer Inform. 2020 Jul.
doi: 10.1200/CCI.20.00068. AffiliationsItem in Clipboard
AbstractPurpose: While there are studies under way to characterize the direct effects of the COVID-19 pandemic on the care of patients with cancer, there have been few quantitative reports of the impact that efforts to control the pandemic have had on the normal course of cancer diagnosis and treatment encounters.
Methods: We used the TriNetX platform to analyze 20 health care institutions that have relevant, up-to-date encounter data. Using this COVID and Cancer Research Network (CCRN), we compared cancer cohorts identified by querying encounter data pre-COVID (January 2019-April 2019) and current (January 2020-April 2020). Cohorts were generated for all patients with neoplasms (malignant, benign, in situ, and of unspecified behavior), with new incidence neoplasms (first encounter), with exclusively malignant neoplasms, and with new incidence malignant neoplasms. Data from a UK institution were similarly analyzed. Additional analyses were performed on patients with selected cancers, as well as on those having had cancer screening.
Results: Clear trends were identified that suggest a significant decline in all current cohorts explored, with April 2020 displaying the largest decrease in the number of patients with cancer having encounters. Of the cancer types analyzed, lung, colorectal, and hematologic cancer cohorts exhibited smaller decreases in size in April 2020 versus 2019 (-39.1%, -39.9%, -39.1%, respectively) compared with cohort size decreases for breast cancer, prostate cancer, and melanoma (-47.7%, -49.1%, -51.8%, respectively). In addition, cancer screenings declined drastically, with breast cancer screenings dropping by -89.2% and colorectal cancer screenings by -84.5%.
Conclusion: Trends seen in the CCRN clearly suggest a significant decrease in all cancer-related patient encounters as a result of the pandemic. The steep decreases in cancer screening and patients with a new incidence of cancer suggest the possibility of a future increase in patients with later-stage cancer being seen initially as well as an increased demand for cancer screening procedures as delayed tests are rescheduled.
Conflict of interest statement Jack W. LondonConsulting or Advisory Role: TriNetX
Stock and Other Ownership Interests: TriNetX
Elnara Fazio-EynullayevaEmployment: TriNetX
Stock and Other Ownership Interests: TriNetX
Matvey B. PalchukEmployment: TriNetX
Stock and Other Ownership Interests: TriNetX
Peter SankeySpeakers’ Bureau: Astellas Pharma
Travel, Accommodations, Expenses: Bayer AG, TriNetX
No other potential conflicts of interest were reported.
FiguresFIG 1.
COVID and Cancer Research Network…
FIG 1.
COVID and Cancer Research Network descriptive statistics and demographics. (A) Distribution of patient…
FIG 1.COVID and Cancer Research Network descriptive statistics and demographics. (A) Distribution of patient age and sex within the network. (B) Geographic distribution split into Northeast, Midwest, South, and West. Network statistics represent the distribution in sizes of individual institutions included in the network.
FIG 2.
The effects of COVID-19 on…
FIG 2.
The effects of COVID-19 on patients with any neoplasm-related encounter. (A) Plot representing…
FIG 2.The effects of COVID-19 on patients with any neoplasm-related encounter. (A) Plot representing patient counts identified by month from January to April in either 2019 (blue) or 2020 (red) using International Classification of Diseases, Tenth Revision, diagnosis codes for all neoplasms, including benign and in situ (C00-D49), with percent change from 2019 to 2020 indicated by gray line. Also shown are patient counts and percent change for each indicated month and year. (B) Patient counts for 2019 (green) and 2020 (orange) from University Hospitals Plymouth NHS Trust in the United Kingdom (UK). Plot and table were generated identically to that shown in panel A. CCRN, COVID and Cancer Research Network.
FIG 3.
The effects of COVID-19 on…
FIG 3.
The effects of COVID-19 on patients with new incidence encounters associated with any…
FIG 3.The effects of COVID-19 on patients with new incidence encounters associated with any neoplasm. (A) Plot representing counts for patients with a new incidence encounter (ie, no previous encounter related to the indicated neoplasm diagnosis) from CCRN data. (B) Patients with new incidence encounters at University Hospitals Plymouth NHS Trust in the United Kingdom (UK). CCRN, COVID and Cancer Research Network.
FIG 4.
The effects of COVID-19 on…
FIG 4.
The effects of COVID-19 on patients with a malignant neoplasm–associated encounter. (A) Patients…
FIG 4.The effects of COVID-19 on patients with a malignant neoplasm–associated encounter. (A) Patients identified by month as previously described, using International Classification of Diseases, Tenth Revision, diagnosis codes for any malignant neoplasm (C00-C96, D37-D49). (B) Counts of patients with new incidence malignant neoplasm diagnosis.
FIG 5.
The effects of COVID-19 among…
FIG 5.
The effects of COVID-19 among cancer types. (A) Patient counts were generated for…
FIG 5.The effects of COVID-19 among cancer types. (A) Patient counts were generated for the indicated month for each cancer type in 2019 and 2020 using International Classification of Diseases, Tenth Revision, diagnosis codes: breast cancer (C50), lung cancer (C34), prostate cancer (C61), colorectal cancer (C18-21), hematologic cancers (C81-96), and melanoma (C43). Percent change from 2019 to 2020 is shown. (B) Patient counts were generated using the diagnosis codes indicated in panel A, filtering on patients with new incidence encounters.
FIG 6.
The effects of COVID-19 on…
FIG 6.
The effects of COVID-19 on cancer screening. Patient counts were generated for breast…
FIG 6.The effects of COVID-19 on cancer screening. Patient counts were generated for breast cancer screening encounters using International Classification of Diseases, Tenth Revision (ICD-10), codes R92.0-R92.2 and Z12.31 and Current Procedural Terminology (CPT) codes 77067 and 1029705 and colorectal cancer screening encounters using ICD-10 code Z12.11 and CPT codes 1022231, 1007534, and 1020217. Percent change from 2019 to 2020 is shown in the indicated months.
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