Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
American College of Surgeons Cancer Programs, Chicago, Illinois.
JAMA Netw Open. 2023 Oct 2;6(10):e2340148. doi: 10.1001/jamanetworkopen.2023.40148.
The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear.
To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020.
The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years.
Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks.
This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.
新冠疫情给癌症的评估和治疗带来了挑战，对新冠患者的资源突然转移使得许多患者的癌症治疗暂停。先前的报告显示，2020 年癌症筛查和诊断大幅下降；然而，癌症治疗服务的改变程度尚不清楚。
评估美国在新冠疫情第一年癌症治疗的变化。
设计、地点和参与者：本回顾性队列研究使用了国家癌症数据库（NCDB）的数据，纳入了 2018 年 1 月 1 日至 2020 年 12 月 31 日期间年龄大于 18 岁的新诊断癌症患者。
主要结果是 2020 年与 2018 年至 2019 年相比，治疗的可及性（治疗时间、旅行距离和多机构治疗）、可用性（癌症治疗的比例变化）和利用率（按治疗方式、医院类型减少）。自回归模型根据前几年的观察结果预测 2020 年的预期结果。
在 NCDB 中，2020 年确定的 1229654 名患者中，有 1074225 名接受了癌症治疗，比预期减少了 16.8%。患者主要为女性（53.8%），中位年龄为 66 岁（IQR，57-74 岁），与 2018 年和 2019 年的人口统计学特征相似。2020 年诊断与治疗之间的中位时间为 26 天（IQR，0-36 天），中位治疗距离为 11.1 英里（IQR，5.0-25.3 英里），与 2018 年和 2019 年相似。2020 年，较少的患者长途旅行（20.2%的患者旅行距离超过 35 英里）。接受化疗（32.0%）、放疗（29.5%）和手术（57.1%）的患者比例与 2018 年和 2019 年相似。总的来说，预计接受手术的患者比预期减少了 146805 人，接受放疗的患者减少了 80480 人，接受化疗的患者减少了 68014 人。学术医院的癌症手术和治疗减少最多，与社区医院的 99 名患者（减少 12.6%）和综合网络的 110 名患者（减少 12.8%）相比，每家医院减少了约 484 名患者（减少 19.0%）。
本研究发现，2020 年被诊断为癌症的患者中，治疗的可及性和可用性保持不变；然而，治疗患者的减少在不同治疗方式中存在差异，在学术医院比在社区医院和综合网络中更为明显，与预期值相比。这些结果表明癌症服务线具有弹性，并构成了大流行期间癌症治疗减少带来的经济损失。
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