ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic led to the delay of routine medical care, including cancer screening, beginning in March of 2020. While screening rates for several cancers, including prostate cancer, rapidly recovered after the first wave of the COVID-19 pandemic, the degree to which this recovery was realized in different populations remains unknown. We sought to determine the association of the COVID-19 pandemic with prostate cancer screening, particularly for traditionally underserved patients. METHOD(S): We performed a retrospective cohort study using electronic health records (EHR) data from the Optum EHR database for male patients between the ages of 55-69 eligible for prostate cancer screening from quarter 1 (Q1) of 2016 through Q2 of 2021. We excluded men with a prior diagnosis of prostate cancer. We performed multivariable analysis to estimate screening over time, adjusting for patient age, race, ethnicity, Census division of residence, and insurance status. RESULT(S): A total of 7,361,765 patients were included. After adjusting for patient demographics, the percentage of eligible patients with prostate cancer screening decreased from 2.2% in Q4 of 2019 to 1.3% in Q2 of 2020. There was a rebound in screening to 2.4% in Q3 of 2020, which is similar to baseline levels, and a subsequent decline to 1.6% in Q2 of 2021. This trend was seen even after stratifying based on age, race, ethnicity, division, and insurance status (Figure 1). CONCLUSION(S): A 40% decline in prostate cancer screening in Q2 of 2020 was observed during the first wave of the pandemic. This returned to baseline by Q3 of 2020. Subsequent decline was seen again through Q2 of 2021, which also coincides with the second wave of COVID-19. This trend was unaffected by patient characteristics, such as age, race, insurance status, or division of residence. While these data suggest that the peak of the pandemic impacted prostate cancer screening trends similarly across different patient demographic groups, further study is required to breakdown if this was due to social distancing, decreased clinic volumes, or other factors.
ABSTRACT
INTRODUCTION AND OBJECTIVE: An important consequence of the COVID-19 pandemic was a precipitous decline in elective outpatient encounters such as cancer screening. It is particularly important to examine the effect of delays in cancer screening as a result of COVID-19-due to the potential for future morbidity, but as of yet, there have been no reports of cancer screening rates throughout the multiple waves of the pandemic on a nationwide level. We sought to examine monthly trends in prostate cancer screening during 2020 to better inform future clinical care. METHODS: To obtain prostate cancer screening rates, we queried the Healthjump dataset which provides outpatient encounter information for more than 40 million patients nationwide and is updated daily. This dataset was obtained through the COVID-19 Resesarch Database. Both encounter and laboratory test data for prostate cancer screening were collected from January 2019 to December 2020 using a combination of ICD-10 and CPT/HCPCS codes. We then analyzed these rates during three time periods: pre-pandemic (Jan 2019-Feb 2020), first wave (Mar 2020-May 2020), and postfirst wave (Jun 2020-Dec 2020). RESULTS: Prior to the pandemic (defined as March 2020) there were an average of 5731 screening visits, 2031 screening PSA labs, and 8173 total PSA labs (not specifically defined as screening) monthly. Between March and May 2020, these numbers declined to 3858, 1613, and 6237 monthly encounters, respectively (p<0.01). In April 2020, rates nadired at 50%, 66%, and 63%, respectively, of their pre-pandemic means. By June of 2020, prostate screening encounters returned to their pre-pandemic rates (Figure 1). CONCLUSIONS: Prostate cancer screening encounters quickly declined in the first 3 months of the COVID-19 pandemic but consistently returned to pre-pandemic rates between June and December 2020. Hopefully this is an indication that decreased prostate cancer screening due to COVID-19 was short-lived and will not lead to more advanced disease at diagnosis in the future. (Figure Presented).