Subject(s)
Ablation Techniques/trends , Barrett Esophagus/surgery , COVID-19 , Esophageal Neoplasms/surgery , Esophagectomy/trends , Esophagoscopy/trends , Administrative Claims, Healthcare , Barrett Esophagus/diagnosis , Databases, Factual , Early Detection of Cancer/trends , Esophageal Neoplasms/diagnosis , Humans , Retrospective Studies , Time Factors , United StatesSubject(s)
Adenoma/diagnosis , Breast Neoplasms/diagnosis , COVID-19 , Carcinoma/diagnosis , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/trends , Uterine Cervical Neoplasms/diagnosis , Adenoma/pathology , Breast Neoplasms/pathology , Carcinoma/pathology , Colorectal Neoplasms/pathology , Female , Humans , Italy , Missed Diagnosis/trends , SARS-CoV-2 , Uterine Cervical Neoplasms/pathologyABSTRACT
ONCOLOGY® co-editor-in-chief Howard S. Hochster, MD, reviews research on delays in oncology care as a results of the COVID-19 pandemic.
Subject(s)
COVID-19/epidemiology , Delayed Diagnosis/trends , Early Detection of Cancer/trends , Neoplasms/diagnosis , Time-to-Treatment/trends , Humans , Medical Oncology/standards , Outcome and Process Assessment, Health Care , Risk Factors , Time-to-Treatment/statistics & numerical dataSubject(s)
Breast Neoplasms/diagnosis , COVID-19 , Early Detection of Cancer/trends , Adult , Aged , Cross-Sectional Studies , Female , Humans , Middle Aged , Safety-net ProvidersABSTRACT
BACKGROUND: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. METHODS: We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FINDINGS: Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities). INTERPRETATION: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. FUNDING: None. TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.
Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/trends , Health Services Accessibility/trends , Medical Oncology/trends , Neoplasms/therapy , Ambulatory Care/trends , COVID-19/diagnosis , Delayed Diagnosis , Early Detection of Cancer/trends , Hospitalization/trends , Hospitals, High-Volume/trends , Humans , India/epidemiology , Neoplasms/diagnosis , Neoplasms/epidemiology , Patient Acceptance of Health Care , Time Factors , Time-to-Treatment , Waiting ListsSubject(s)
COVID-19 , Community Health Planning , Early Detection of Cancer , Lung Neoplasms/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Change Management , Community Health Planning/methods , Community Health Planning/standards , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , Early Detection of Cancer/trends , Humans , Lung Neoplasms/mortality , Risk Assessment/methods , SARS-CoV-2 , United States/epidemiologyABSTRACT
BACKGROUND: The restructuring of healthcare systems to cope with the demands of the COVID-19 pandemic has led to a reduction in clinical services such as cancer screening and diagnostics. METHODS: Data from the four Northern Ireland pathology laboratories were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, sex and age. These trends were compared to the same timeframe from 2017 to 2019. RESULTS: Between 1st March and 12th September 2020, there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding 3 years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50-59-year-old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses. CONCLUSIONS: There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.
Subject(s)
COVID-19/epidemiology , Early Detection of Cancer/statistics & numerical data , Healthcare Disparities , Neoplasms , Adolescent , Adult , Aged , Aged, 80 and over , Early Detection of Cancer/trends , Female , Healthcare Disparities/statistics & numerical data , Healthcare Disparities/trends , History, 21st Century , Humans , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/epidemiology , Northern Ireland/epidemiology , Pandemics , Registries , Retrospective Studies , Time Factors , Young AdultABSTRACT
INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted breast, colon, prostate, and lung cancer screenings in the U.S. by decreasing screening numbers.âWe believe multiple types of cancer screenings may have been impacted during the pandemic as a result of cancellations of elective procedures and patient fear of seeking cancer screenings during a pandemic and that Google Trends may be a marker to estimate screening usage. METHODS: Google Trends (trends.google.com) was utilized to assess public interest in multiple cancer types. We then constructed a forecasting model to determine the expected search interest had the pandemic not occurred. We then compared our models to actual screening usage during the pandemic. RESULTS: Public interest in cancer screenings decreased precipitously at the onset of the COVID-19 pandemic. We found that the Google Trends estimated the decrease in mammogram usage 25.8% below the actual value. Similarly, Google Trends estimated the decrease in colon cancer screening usage 9.7% below the true value. DISCUSSION: We found the decrease in public interest in breast and colon cancer screenings slightly underestimated the actual screening usage numbers, suggesting Google Trends may be utilized as an indicator for human behavior regarding cancer screening, particularly with colon and breast cancer screenings. If the negative trend in cancer screening continues and missed screenings are not appropriately corrected for, socioeconomic and racial disparities in cancer diagnoses, morbidity, and mortality will widen.
Subject(s)
COVID-19/prevention & control , Early Detection of Cancer/trends , Neoplasms/diagnosis , Patient Acceptance of Health Care/statistics & numerical data , COVID-19/epidemiology , COVID-19/psychology , COVID-19/transmission , Early Detection of Cancer/psychology , Early Detection of Cancer/statistics & numerical data , Fear , Female , Humans , Information Seeking Behavior , Internet Use/statistics & numerical data , Internet Use/trends , Male , Pandemics/prevention & control , Patient Acceptance of Health Care/psychology , United States/epidemiologySubject(s)
COVID-19 , Digestive System Neoplasms/diagnosis , Early Detection of Cancer/trends , Endoscopy, Gastrointestinal/trends , Gastroenterology/trends , Databases, Factual , Digestive System Neoplasms/epidemiology , Humans , Predictive Value of Tests , Retrospective Studies , Time Factors , United States/epidemiologySubject(s)
COVID-19 , Early Detection of Cancer/trends , Neoplasms/diagnosis , COVID-19/psychology , Cancer Survivors , Early Detection of Cancer/psychology , Early Detection of Cancer/statistics & numerical data , Humans , India , Oncology Service, Hospital/statistics & numerical data , Socioeconomic FactorsSubject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Early Detection of Cancer , Lung Neoplasms , Preventive Health Services/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Feasibility Studies , Humans , Infection Control/methods , Italy/epidemiology , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Lung Neoplasms/prevention & control , Organizational Innovation , Program Evaluation , SARS-CoV-2ABSTRACT
BACKGROUND: The SARS-CoV-2 pandemic has had a huge impact on healthcare systems, resulting in many routine diagnostic procedures either being halted or postponed. AIMS: To evaluate whether the diagnoses of colorectal, gastric and pancreatic cancers have been impacted by the SARS-CoV-2 pandemic in Italy. METHODS: A survey designed to collect the number of histologically-proven diagnoses of the three cancers in gastroenterology services across Italy from January 1 to October 31 in 2017-2020. Non-parametric ANOVA for repeated measurements was applied to compare distributions by years and macro-areas. RESULTS: Compared to 2019, in 2020 gastric cancer diagnoses decreased by 15.9%, CRC by 11.9% and pancreatic by 9.9%. CRC distributions showed significant differences between all years, stomach cancer between 2018 and 2020 and 2019-2020, and pancreatic cancer only between 2017 and 2019. The 2019-2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%), fewer stomach cancers in the North (-19.0%) and South (-9.4%), and fewer pancreatic cancers in the North (-14.1%) and Center (-4.7%), with an increase in the South (+12.3%). Distributions of CRC and gastric cancer were significantly different between all years in the North. CONCLUSIONS: This survey highlights the concerning effects of the COVID-19 pandemic on the diagnostic yield of gastroenterology services for stomach, colorectal and pancreatic cancers in Italy.
Subject(s)
COVID-19 , Delivery of Health Care , Digestive System Neoplasms , Early Detection of Cancer , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Diagnostic Techniques, Digestive System , Digestive System Neoplasms/diagnosis , Digestive System Neoplasms/epidemiology , Early Detection of Cancer/methods , Early Detection of Cancer/trends , Gastroenterology/methods , Gastroenterology/statistics & numerical data , Humans , Infection Control/methods , Italy/epidemiology , Organizational Innovation , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
PURPOSE: 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.
Subject(s)
Coronavirus Infections/epidemiology , Early Detection of Cancer/trends , Neoplasms/classification , Neoplasms/epidemiology , Pneumonia, Viral/epidemiology , COVID-19 , Cohort Studies , Comorbidity , Female , Humans , Incidence , Male , Pandemics , United Kingdom/epidemiology , United States/epidemiologySubject(s)
COVID-19 , Early Detection of Cancer/trends , Health Services Accessibility/trends , Melanoma/diagnosis , Patient Acceptance of Health Care/statistics & numerical data , Skin Neoplasms/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Humans , Incidence , Melanoma/epidemiology , Pandemics , Retrospective Studies , Skin Neoplasms/epidemiology , Spain/epidemiologyABSTRACT
OBJECTIVES: We performed data collection concerning the coronavirus disease 2019 (COVID-19) pandemic-related delay in the diagnosis of cancers to individuate proper corrective procedures. METHODS: A comparison was made among the number of first pathologic diagnoses of malignancy made from weeks 11 to 20 of 2018, 2019, and 2020 at seven anatomic pathology units serving secondary care hospitals in northern-central Italy. RESULTS: Cancer diagnoses fell in 2020 by 44.9% compared with the average number recorded in 2018 and 2019. Melanoma and nonmelanoma skin cancer represented 56.7% of all missing diagnoses. The diagnostic decrease in colorectal (-46.6%), prostate (-45%), and bladder (-43.6%) cancer was the most relevant among internal malignancies; for prostate, however, high-grade tumors were only moderately affected (-21.7%). CONCLUSIONS: Diagnosis of cutaneous malignancies was mostly affected by the lockdown; among internal malignancies, corrective actions were mostly needed for colorectal cancer and invasive bladder cancer.
Subject(s)
COVID-19/prevention & control , Delayed Diagnosis/trends , Early Detection of Cancer/trends , Neoplasms/diagnosis , Physical Distancing , COVID-19/epidemiology , Humans , Italy/epidemiology , PandemicsSubject(s)
COVID-19 , Early Detection of Cancer/trends , Neoplasms/diagnosis , Aged , Colonoscopy/statistics & numerical data , Female , Humans , Male , Mammography/trends , Massachusetts/epidemiology , Middle Aged , Neoplasms/epidemiology , Papanicolaou Test/trends , Prostate-Specific Antigen/blood , SARS-CoV-2 , Tomography, X-Ray Computed/trendsSubject(s)
Anus Neoplasms/diagnosis , COVID-19 , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/trends , Health Services Accessibility/trends , Adult , Aged , Aged, 80 and over , Anus Neoplasms/economics , Anus Neoplasms/epidemiology , Anus Neoplasms/pathology , Brazil/epidemiology , Colorectal Neoplasms/economics , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/pathology , Cross-Sectional Studies , Early Detection of Cancer/economics , Female , Health Services Accessibility/economics , Humans , Male , Medically Uninsured/statistics & numerical data , Middle Aged , Neoplasm Staging , Referral and Consultation/economics , Referral and Consultation/trendsABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to many aspects of life in Australia and globally. This includes actual and potential future impacts on Australia's three national screening programs for breast, bowel and cervical cancer. These programs aim to improve cancer outcomes through an organised approach to the early detection of cancer and precancer in asymptomatic populations. The design of each program varies according to biological differences in the three cancers, the available screening technology, the target population, and variations in their administration of Australia's federal, state and territory jurisdictions. The observed and potential impacts of COVID-19 on these programs, and on related activities such as the current national enquiry into lung cancer screening feasibility, therefore vary significantly. This article focuses on observed short-term impacts, adaptations and the longer-term outlook for cancer screening in relation to COVID-19. It summarises potential responses to minimise the harms of disruptions caused by COVID-19, and highlights research and policy opportunities in the pandemic response and recovery which could inform and accelerate optimisation of cancer screening in the long term.