New research from the American College of Surgeons (ACS) outlines significant ways that the COVID-19 pandemic destabilized usual patterns of cancer care as reported in the National Cancer Database (NCDB), one of the largest cancer registries in the world used by thousands of hospitals and centers around the country to inform and improve the quality of cancer care.
The research, published in JAMA Surgery as a Special Communication article, describes specific ways that NCDB data models were impacted by the pandemic, offering guidance to centers across the country on how to interpret data from 2020 and onwards. The research also paints a much larger picture of the many disruptions caused by the pandemic outside of the immediate emergency of treating COVID-19 patients.
While monitoring real-time data submissions, the ACS Cancer Programs, which manages the NCDB with the American Cancer Society, noted variances in new cancer diagnoses in the first several months of 2020. These variances marked a significant change from the historically stable dataset, which collects more than 1.5 million new cancer cases each year, representing more than 70% of all cancer cases in the United States.
For the study, researchers reviewed 4,045,097 cancer cases from adults 18 years or older who were diagnosed with cancer and/or received their first-course treatment at a reporting facility from January 1, 2018, through December 31, 2020. Reporting facilities included CoC-accredited programs, excluding Veterans Affairs-affiliated programs.
The study offers a detailed look into the complexities and variations that occurred in cancer reporting as a result of the pandemic. Among the key findings:
- The COVID-19 pandemic was associated with significant changes in diagnoses of all cancer types in 2020, with a 14.4% overall decline in the number of reported cancer cases in the NCDB compared with the prior year. This decline represents more than 200,000 cancer cases that were not diagnosed and/or treated at CoC facilities.
- These missing cancer cases are expected to appear in 2021 data and beyond, potentially at more advanced stages.
- Overall, the proportion of patients diagnosed with early-stage disease decreased from March to June 2020, followed by a corresponding increase in the proportion of those diagnosed with late-stage disease, peaking in April 2020 and correcting to prior years’ percentages by July 2020. However, the 2020 stage distributions for specific types of cancer varied.
- The study identified differences across sociodemographic data. Overall, the proportion of White patients with cancer significantly increased, while the proportion of Asian or Pacific Islander, Hispanic, Black, and other/unknown patients with cancer significantly decreased. This finding suggests that certain racial and ethnic groups were less likely to be diagnosed with cancer and/or receive cancer care, potentially exacerbating existing health disparities in cancer treatment.
- Significant disparities were noted between age groups, with increases in cancer rates in people 60 to 69 years old and 70 to 79 years old, and decreases in age of diagnosis in younger and older age categories throughout 2020. This finding suggests that patients younger than 60 and those older than 80 were less likely to be diagnosed or treated for cancer compared with past years.
