Pandemic Cancer Incidence Observance Shows Further Recovery Still Needed

A study observed differences between expected and observed cancer incidence in 2020 and 2021 to evaluate the pandemic’s disruption of cancer detection.

More than 125,000 cancer cases may have been missed due to pandemic-related disruptions to cancer care services in 2020, according to a study published in JAMA Open Network.Additionally, although cancer incidence rates increased to around projected levels in 2021, the increase did not account for the 2020 deficit, suggesting a need to address numerous patients with potentially undiagnosed cancers.

Findings from the study reveal that there was a deficit in observed cancer incidence when compared with forecasted cancer incidence in 2020, with 418.90 (95% CI, 417.94-419.86) per 100,000 observed cancer incidence vs 458.12 (95% CI, 456.71-459.54) per 100,000 forecasted cancer incidence. The translated estimated numerical deficit in 2020 was a difference of –125,167 cases (95% CI, –131,771 to –118503) between forecasted and observed cases. In 2021, the estimated deficit was –2764 cases (95% CI, –11833 to 6402).

“Incidence of cancer detection recovered meaningfully in 2021 following substantial disruptions in 2020. However, 127,931 patients were estimated to have undiagnosed cases nationally during the pandemic in 2021, which could have profound, long-lasting impacts,” Uriel Kim, MD, PhD, MBA, resident physician at Cedar-Sinai Medical Center, wrote in the publication with study coinvestigators. “Thus, it remains essential to rapidly reestablish care for patients with undiagnosed cancer during the pandemic to prevent the exacerbation of disparities in cancer outcomes and increased cancer-related morbidity and mortality in future years.”

The cross-sectional study included 15,831,912 patients diagnosed with a malignant cancer between January 1, 2000, and December 31, 2021, with a trend model trained on patients diagnosed between 2000 and 2019 (n = 14,246,457) to project cancer incidence in 2020 and 2021.

The median age of evaluable patients was 65 years (IQR, 56-75) and 51.0% of participants were males. Furthermore, 72.4% of patients were White, 11.1% were Hispanic, 10.4% were Black, 5.0% were Asian or Pacific Islander, 0.4% were Native American or Alaska Native, and 0.8% were defined as unknown race.

Subgroup analyses reveal the impact of pandemic-related disruptions by demographic characteristics, particularly for male patients (–8.4% [95% CI, –8.8% to –8.0%]), non-US-born residents (–10.2% [95% CI, –10.3% to –10.2%]), and those living in extreme urban (–10.0% [95% CI, –10.2% to –9.7%]) or rural (–9.5% [95% CI, –11.2% to –7.8%]) areas, which all saw significant decreases during the pandemic. All subgroup incidence rates improved in 2021, however, those living in the most rural counties were still associated with substantially lower cancer incidence rates (–4.9% [95% CI, –6.7% to –3.7%]).

Furthermore, multiple cancer sites had continued depressed rates going into 2021 from 2020, including gallbladder (–7.1%), as well as eye and orbit (–8.3%). Furthermore, some cancer sites saw a partial recovery in 2021 but statistically significantly lower cancer incidence rates compared with projections, which include; larynx (–4.5%); lung and bronchus (–5.0%); soft tissue, including heart (–3.5%); kidney and renal pelvis (–5.0%); and thyroid (–6.5%).

The cancer sites with the largest cumulative deficits in expected cases over the 2-year span included the lung and bronchus (−24,940 [95% CI, −28,936 to −20,944]), prostate (−14,104 [95% CI, −27,472 to −736]), and melanoma (−10,274 [95% CI, −12,825 to −7724]).

Reference

Kim U, Rose J, Carroll BT, et al. Recovery from COVID-19–related disruptions in cancer detection. JAMA Netw Open. 2024;7(10):e2439263. doi:10.1001/jamanetworkopen.2024.39263