COVID-19 Fallout May Lead to More Cancer Deaths

Significant declines in CT imaging for cancer persisted even after the peak of the COVID-19 pandemic in 2020, delaying diagnosis and treatment and raising the possibility of more advanced cancers and worse outcomes for patients in the future, according to a study to be presented next week at the annual meeting of the Radiological Society of North America (RSNA).

Numerous studies have shown the severe impact of COVID-19 on U.S. healthcare as the pandemic filled hospitals and reduced imaging capacity during its peak March to early May 2020. Few studies, however, have documented the lingering effects of the pandemic on cancer imaging. examined.

For the new study, researchers from Massachusetts General Hospital (MGH) and Harvard Medical School in Boston compared cancer-related CT exams over three 2020 periods: the pre-COVID phase (January to mid-March), peak COVID (mid-March to May) and post-COVID peak (May to mid-November). They looked at the CT volume and the type of care delivered via imaging.

As expected, CT volumes dropped significantly during the COVID peak. CT for cancer screening fell by as much as 82%, while CT for initial workup, active cancer and cancer surveillance also showed significant decreases. Cancer screening and initial workup volumes did not recover in the post-COVID peak period and remained 11.7% and 20% lower than their pre-COVID rates, respectively.

“The decline during the COVID peak was expected due to stay-at-home orders and the number of imaging departments that were closed as a precaution,” said senior author Marc Succi, MD, an emergency radiologist at MGH and executive director of the MESH Incubator, an internal innovation and entrepreneurship center . “Once normal operations resumed, you would expect these patients to be portrayed fairly, but in fact that turned out not to be the case.”

The continued decline in CTs for cancer screening and initial workup likely means there will be more patients with advanced cancers in the future.

“We expect to see increased morbidity and mortality due to the fact that these patients were unable to receive their routine imaging,” said Dr. succi. “You can also assume that they probably didn’t have their routine elective follow-up appointments either.”

The decline in CT imaging particularly impacted the outpatient setting as use shifted from large academic centers to community hospitals and the emergency department (ED). Cancer-related CTs in the emergency room even increased in the post-COVID peak period.

“The emergency room remains a place in the American health care system where people can get help no matter the situation,” said study author Ottavia Zattra, a fourth-year medical student at Harvard Medical School. “However, from a systems perspective, the best prevention care is provided on an outpatient basis.”

The possibility of being exposed to COVID-19 likely made many cancer patients reluctant to enter major hospitals and primary care centers, the researchers said. As a result, they may have postponed a visit until the symptoms became too important to ignore.

“When the initial diagnostic imaging is done in the emergency room, it suggests that people had symptoms due to cancer for months and months, and they didn’t check in with their primary care providers,” Zattra said. “Eventually, the symptoms got so bad they couldn’t handle it at home.”

The research results underline the vulnerable position of cancer patients in the pandemic.

“We need better awareness and outreach to the oncology patient population,” said Dr. succi. “For example, if a patient has to undergo an annual lung cancer screening with a CT scan, we need to make sure they are aware that they can and should get that screening regardless of COVID. Delays in screening will inevitably lead to delayed diagnoses and increased morbidity.”

The trends in the use of imaging support the shift of more resources to community centers to care for patients who might avoid large teaching hospitals. The trends also highlight the importance of a robust ED imaging service with nightly coverage in both academic medical centers and private practices.

“Even the smaller centers should think about 24/7 coverage for ED imaging to meet the needs of these patients being diverted,” said Dr. succi.

The researchers hope to conduct a follow-up study through 2021 to track CT imaging volumes. They also want to look at the role factors such as race, language and income played in accessing cancer imaging during the pandemic.

Co-authors are James Brink, MD, Sanjay Saini, MD, Michael Lev, MD, Michael S. Gee, MD, Ph.D., and Min Lang, MD