Disruptions in cancer screening and diagnoses during the COVID-19 pandemic in 2020.

Abstract

315 Background: The pandemic resulted in reductions in cancer screenings, potentially compromising the ability to detect cancers early. We add new data to this growing research, and report screening and cancer diagnosis (Dxs) rates for four cancer types: breast (BC), cervical (CC), colorectal (CRC), and lung (LC). To learn whether home-based cancer screening options for colorectal cancer exhibited similar patterns, we examined screening rates for fecal occult blood (FOBT), fecal immunochemical (FIT), and Cologuard (CG) tests. Methods: We conducted retrospective analyses using de-identified medical claims data (2018-2020) from a national US health insurer. To assess screening rates, no indication of cancer Dxs prior to screening event were included. BC screenings (BCS), LC screenings (LCS), and CRC screenings (CRCS) were identified from CPT and HCPCS codes for digital mammography, low dose CT-scans (LDCT), colonoscopies, and home-based CRC tests. CPT, HCPCS, and ICD-10 codes defined CC screenings (CCS). Cancer Dxs were defined if individuals had ≥1 claim with an ICD-10 cancer code and no prior cancer dx within 24 months of continuous eligibility. Advanced cancer Dxs (ADxs) were defined if a malignancy code on a claim with a date of service (DOS) within 60 days of diagnosis DOS was present. Screening and Dxs changes were compared circa mid-March (5 weeks prior and 5 weeks after). Adjustments were made for changes in enrollment. Results: The table summarizes screening changes. Dxs decreased circa shutdown in LC, BC, CS, and CRC by -40%, -61%, -55%, -55%, respectively. Compared to 2019, DXs decreased in LC, BC, CS, and CRC -19%, -16%, -6%, -18%, respectively. Compared to 2019, ADxs in LC, BC, and CRC were -14%, -9%, -8%, respectively. CS exhibited an increase in ADxs by 2%. Conclusions: The pandemic impacted cancer care for multiple cancer types. Dxs and ADxs decreased during the pandemic except advanced CS. While cancer screenings increased after the shutdown, only LCS and Cologuard returned to pre-pandemic levels by the end of 2020, though these had low utilization even in the periods prior to the pandemic. Limitations include that administrative programs supporting home-based tests (e.g. FIT and FOBT) may not generate claims, and procedures received may have been incorrectly coded. Future studies will assess the clinical impact of missed care and whether certain groups were disproportionately impacted.[Table: see text]