Reduction in Cancer Screenings During COVID-19 May Lead to More Late-Stage Disease, Poorer Outcomes

A decrease in screening CT scans during the height of the COVID-19 pandemic in 2020 may result in more cases of late-stage cancer due to delayed diagnosis and poorer outcomes for patients, according to the results of a study presented at the Radiological Society of North America annual meeting.

The trial assessed cancer-related CT scans during 3 periods in 2020, including January to mid-March (pre–COVID-19), mid-March to May (peak COVID-19), and May to mid-November (post–COVID-19 peak). Investigators noted that CT scans to detect cancer fell by 82% during the peak of COVID-19, with scans for initial workup, active disease, and surveillance all declining significantly. Volume for disease screenings and initial workup did not recover within the post–COVID-19 peak period, which were down by 11.7% and 20%, respectively, from the pre–COVID-19 period.

“The decline during the COVID peak was expected because of stay-at-home orders and the number of imaging departments that shut down as a precaution,” senior study author Marc Succi, MD, an emergency radiologist at Massachusetts General Hospital and executive director of the MESH Incubator, said in a press release. “Once normal operations resumed, you’d expect that these patients were being imaged in an equitable way, but, in fact, it turns out that they weren’t.”

In particular, decreases in CT imaging were notable in the outpatient setting, with a shift away from large academic centers to community practices and emergency departments. Moreover, emergency departments experienced an increase in cancer-related CT scans during the post–COVID-19 peak period. Investigators theorize that the decline in scans for cancer and initial workup are likely to result in an increased number of patients with advanced disease in the future.

As the threat of COVID-19 exposure dissuaded patients with cancer from going to large hospitals or primary care centers, it is likely that patients put off their visit until they were significantly symptomatic.

“When initial diagnostic imaging is done in the emergency room, that suggests that people were having symptoms due to cancer for months and months, and they weren’t checking in with their primary care providers,” Ottavia Zattra, a fourth-year medical student at Harvard Medical School, noted. “Ultimately, the symptoms got so bad they couldn’t handle it at home.”

Additionally, trends in imaging utilization support diverting additional resources to community centers to care for any individuals who may not want to visit larger institutions. Findings from the study could also indicate that emergency departments with robust imaging and overnight coverage could be important for both academic medical centers and private practices.

Reference

COVID-19 fallout may lead to more cancer deaths. News release. Radiological Society of North America. November 24, 2021. Accessed November 29, 2021. https://bit.ly/3G0p0jg