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1.
Annals of Surgical Oncology ; 20:20, 2022.
Article in English | MEDLINE | ID: covidwho-2196735

ABSTRACT

PURPOSE: This study evaluated the reliability of cancer cases reported to the National Cancer Database (NCDB) during 2020, the first year of the COVID-19 pandemic.

2.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | Web of Science | ID: covidwho-2093200
3.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009540

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in delayed medical care that may have led to increased death rates in 2020 among people with medical conditions such as cancer. This study examined changes in cancer-related mortality between 2019 and 2020. Methods: We used the US 2019-2020 Multiple Cause of Death database from the CDC WONDER to identify cancer-related deaths, defined as decedents with invasive or noninvasive cancer as a contributing cause of death (ICD-10 codes: C00-C97 and D00-D09). We compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020 (pandemic) versus January-December 2019 (pre-pandemic) overall and stratified by rurality and place of death. We calculated the 2020 excess death by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rate from 2015 to 2019. Results: The number of cancer-related deaths was 686 054 in 2020, up from 664 888 in 2019, with an annual increase of 3.2%. Compared to the number of projected deaths for 2020 (666 286), the number of cancer-related excess deaths was 19 768 in 2020. Annual age-standardized cancer-related mortality rate (per 100,000 person-years) continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020 (2020 vs 2019 rate ratio (RR): 1.013, 95% confidence interval (CI): 1.009 - 1.016). The cancer-related monthly mortality rate was higher in April 2020 (RR: 1.032, 95% CI: 1.020 - 1.044) when healthcare capacity was most challenged by the pandemic, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019. In large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020, coinciding with the time-spatial pattern of COVID-19 incidence in the country. Compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in decedent's homes. Conclusions: The COVID-19 pandemic led to significant increases in cancer-related deaths in 2020 versus 2019. Ongoing evaluation of the spatialtemporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.

4.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009516

ABSTRACT

Background: Implementation of the Affordable Care Act (ACA) has resulted in improvements in cancer outcomes but the extent to which these apply to specific racial and ethnic populations is unknown. We examined changes in health insurance distributions pre- and post-ACA and assessed cancer-specific mortality rates by race and ethnicity. Methods: The population included 167,181 newly diagnosed breast (n = 117,738), colorectal (n = 38,334), and cervix cancer (n = 11,109) patients younger than 65 years and 141,026 patients 65 years or older in the California Cancer Registry. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression to estimate associations with risk of 5-year cancer-specific death for each cancer site pre- (2007-2010) and post-ACA (2014-2017), and by race and ethnicity (American Indian/Alaska Natives, AIAN;Asian Americans;Hispanics;Native Hawaiian/Pacific Islanders, NHPI;non-Hispanic Blacks, NHB;and non- Hispanic whites, NHW). Difference-in-difference analysis was conducted to compare changes over time between younger (< 65 years) and older (65 years and older) patients. Results: Cancer-specific mortality for patients age < 65 was significantly lower post- vs. pre-ACA for colorectal cancer among Hispanic (HRR = 0.83;95% CI: 0.74-0.93), NHB (HRR = 0.69;95% CI: 0.58-0.81), and NHW (HRR = 0.90 95% CI: 0.84-0.97) but not Asian American (HRR = 0.95;95% CI: 0.82-1.10) patients. The HRR for younger NHB colorectal cancer patients was significantly lower than that for patients 65 years of and older (HRR = 1.09;95% CI, 0.95-1.25, p-interaction < 0.0001). A significantly lower risk of dying from cervix cancer was observed in the post- vs. pre-ACA period among younger NHB women (HRR = 0.68;95% CI: 0.47-0.99), but this was not significantly different than that for older women (HRR = 0.41;95% CI, 0.16-1.01, p-interaction = 0.30). No significant differences in breast cancer-specific mortality were observed for any racial or ethnic group. Conclusions: Findings show decreases in cancer-specific mortality for colorectal and cervix cancers for some racial and ethnic groups following ACA implementation in California. These results shed light on ongoing discussions as additional states consider Medicaid expansion. Future studies should assess shifts between health insurance plans resulting from the economic impact of the 2019 novel coronavirus (COVID-19) pandemic.

5.
Journal of Clinical Oncology ; 39(28):3, 2021.
Article in English | Web of Science | ID: covidwho-1486607
6.
Clinical Cancer Research ; 26(18 SUPPL), 2020.
Article in English | EMBASE | ID: covidwho-992098

ABSTRACT

Introduction: During the COVID-19 pandemic, the unemployment rate has sharply risen from 3.5% in February2020 to 13.3% in May 2020, a level not seen since the Great Depression. There are an estimated 21.0 millionunemployed adults in the United States. Employers are the most common source of health insurance amongworking-aged adults and their families. Thus, job loss may lead to loss of insurance and reduce access to cancerscreening, which can detect cancer at earlier, more treatable stages, and reduce cancer mortality. In this study, weexamined sequential associations between unemployment, health insurance, and cancer screening to informCOVID's potential longer-lasting impacts on early cancer detection. Methods: Up-to-date (UTD) and recent (past-year) breast (BC) and colorectal cancer (CRC) screening prevalence were computed among respondents aged 50-64 years in 2000-2018 National Health Interview Survey data.Respondents were grouped as unemployed (not working but looking BC n=852;CRC n=1,747) and employed(currently working BC n=19,013;CRC n= 36,566). A series of logistic regression models with predicted marginalprobabilities were used to estimate unemployed vs. employed unadjusted (PR) and adjusted prevalence ratios(aPR) and corresponding 95% Confidence Intervals (CI). Results: Unemployed adults were four times as likely to be uninsured as employed adults (41.4% v 10.0%, p-value<0.001). Unemployment was associated with lower UTD breast (67.8% vs 77.5%, p-value<0.001, PR=0.82, 95%CI0.77,0.87) and colorectal (49.4% and 60.1%, p-value<0.001, PR=0.86, 95%CI 0.80, 0.92) cancer screeningprevalence. These differences remained after adjusting for race/ethnicity, age, and sex, but were eliminated afteraccounting for health insurance. Patterns and magnitudes of PR and aPRs were similar for past-year CRC and BCscreening prevalence. Conclusion: Unemployment was adversely associated with guideline-recommended and potentially life-savingbreast and colorectal cancer screening. Compared to the employed, the unemployed disproportionately lackedhealth insurance, which accounted for their lower cancer screening utilization. Expanding and ensuring healthinsurance coverage after job loss may mitigate COVID-19's economic impacts on cancer screening.

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