Fewer visits, fewer diagnoses: How the decline in preventative care during the pandemic affects cancer patients

At the start of the pandemic, the American Cancer Society recommended postponing non-essential cancer screenings to reduce the strain on the medical system. Because of these reduced screenings, cancer diagnoses have dropped since the first cases of COVID-19 were recorded. As the pandemic persists, understanding this drop in diagnoses is critical to ensure that doctors move forward in a way that balances the risks of the coronavirus with the importance of catching cancers early. 

A study recently published in The Lancet: Oncology found that there was a decline in cancer cases in the Netherlands after the country’s first confirmed case of COVID-19. Diagnoses for all cancers, excluding skin cancers, had decreased by 26 percent, while those for skin cancers had decreased by 60 percent. 

Similar findings have been seen in the U.S. An analysis by the Epic Health Research Network reported a nationwide drop in preventative cervical, colon, and breast cancers by 86 – 94 percent. The University of Pennsylvania Health System reported an 80 percent drop in skin cancer diagnoses. 

Patients may delay seeking care because they perceive their concern as nonurgent, do not want to strain the medical system for non-coronavirus related issues, or have concerns about the risk of coronavirus transmission in the medical setting.

The reasons for these declines are complex, as different barriers are seen at each level of clinical care. Patients may delay seeking care because they perceive their concern as nonurgent, do not want to strain the medical system for non-coronavirus related issues, or have concerns about the risk of coronavirus transmission in the medical setting. Additionally, many annual visits are postponed, so patients may miss opportunities to be reminded of critical cancer screenings.

The rising use of telemedicine has also affected the number of cancer diagnoses. Providers conducting appointments via telehealth may be unable to investigate certain symptoms further, which could delay their ability to send referrals to specialists. Diagnostic evaluations may be delayed as hospitals need to allocate more resources to combating the coronavirus. 

Many countries, including the Netherlands, have also paused national screening programs for breast, colorectal, and cervical cancer because of the increased strain on the health system. This level of clinical care has the broadest impact, as every patient and provider in the country is affected by policy change. 

Many countries, including the Netherlands, have also paused national screening programs for breast, colorectal, and cervical cancer because of the increased strain on the health system.

Whether these diagnostic delays end up changing the patient’s prognosis depends on the type of cancer. For example, for colorectal cancer, screening typically consists of a colonoscopy every ten years, so a delay on the scale of months may not affect the prognosis for most patients. However, for more aggressive cancers such as inflammatory breast cancer, an early diagnosis can significantly improve outcomes. Similarly, invasive melanomas also should be diagnosed as early as possible, which makes the steep drop in skin cancer diagnoses particularly troubling.

Taking proper precautions during this pandemic is of the utmost importance, and delaying certain procedures may be necessary as hospitals brace for an increase in cases and ensure that they have enough resources to fight the disease. Additionally, existing cancer patients are especially vulnerable to the coronavirus, as many cancer treatments are immunosuppressive, so hospitals must allocate more resources to these patients as well. 

The potential impact on cancer mortality rates remains to be seen, and it will likely vary depending on the type of cancer. 

As the U.S. begins to reopen, it is important to see whether these diagnostic trends change — will there be a compensatory increase in diagnoses compared to baseline, or will the diagnoses stay low? Furthermore, the potential impact on cancer mortality rates remains to be seen, and it will likely vary depending on the type of cancer. 

However, as this epidemic threatens to become endemic, it is vital to understand how to best promote preventative care while also protecting patients from the coronavirus. To this end, it is important for patients and providers to discuss the risks and benefits of receiving cancer screenings as well as which screenings should and should not be delayed. 

The Lancet: Oncology (2020). DOI: 10.1016/S1470-2045(20)30265-5

JAMA: The Journal of the American Medical Association (2020). DOI: 10.1001/jama.2020.6236

The New England Journal of Medicine (2020). DOI: 10.1056/NEJMms2009984

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