Deferred care can result in worse outcomes, advanced complications, or earlier death for many patients with cancer, heart disease, and other serious illnesses.
As the coronavirus disease 2019 (COVID-19) pandemic continues to result in deferred care for many screenings and non-urgent treatments, investigators have found a significant drop in screenings for lung cancer and an increase in malignancy rates during surges of the virus.
Lapses in care present major challenges for providers and institutions caring for patients infected with COVID-19 as well as those in need of timely care for cancer, heart disease, and other serious illnesses. Deferred care can result in worse outcomes, advanced complications, or earlier death for many patients. Investigators at the University of Cincinnati have identified a framework to help individuals with serious health conditions keep up with their appointments during surges.
The team compared monthly visits for low-dose computed tomography (LDCT) screening for lung cancer during the 3 months in which COVID-19 restrictions were in place with the number of monthly visits from 3 years before that. LDCT is known to reduce lung cancer mortality by at least 20% in high-risk patients. The University of Cincinnati College of Medicine suspended LDCT screenings on March 13, 2020 and began a phased reopening on May 5 with a full opening on June 1.
“We had 800 scans cancelled during that time, and even during the resumed period we had a decreased total volume of patients scanned, and also noted a decreased number of new patients who were scanned for their lung cancer screening,” said lead author Robert M. Van Haren, MD, MSPH, FACS, in a prepared statement.
Before the pandemic, the institution averaged 146 LDCT scans per month compared to 39 in March to June of 2020. New patient monthly averages fell from 56 to 15 during the period of investigation and have remained low.
“Also, when we resumed our operations, we found that new patients were less likely to come back to our screening program,” Van Haren said in the statement. “We also found that patients were more likely not to show up for their CT appointments, and this rate was again significantly increased compared with baseline.”
The no-show rate went from 15% prior to the COVID-19 restrictions to 40% afterward. Furthermore, when full operations resumed in June, 29% of patients were found to have lung nodules suspicious for malignancy compared to 8% before the restrictions, meaning more patients were referred to specialists for either biopsy or surgery.
Van Haren said the decreased screening rates probably reflect patient fears about entering health facilities during the pandemic, although their study did not examine these concerns specifically. To reassure patients, the setting for LDCT scans was changed from the hospital to an outpatient center, and other changes included enforcing social distancing in the waiting rooms and scanning areas, and spacing appointments further apart to allow for better cleaning of those areas.
“We’ve done 2 things to try to deal with that situation,” Van Haren said. “One was that we made operational changes to ensure that screening is safe, and we made a big emphasis within uor program and with our nurses and coordinators to educate patients about those changes and to really get the message out that screening is safe.”
Van Haren concluded that their results demonstrate the importance of continuing cancer screenings during the pandemic and educating patients on safety procedures implemented in medical facilities.
“Our results are important and suggest that it’s critical to continue cancer screening operations, such as our lung cancer screening, during this pandemic,” Van Haren concluded. “It’s maybe more important now as we continue to undergo another surge of COVID-19 cases throughout the country.”
Study reports drop in lung cancer screening, rise in malignancy rates during spring COVID-19 surge [news release]. American College of Surgeons; December 17, 2020. https://www.facs.org/media/press-releases/2020/lung-screening-121720. Accessed December 18, 2020.