BALTIMORE — In 2020, compared with baseline years 2018 through 2019, more than 2,000 fewer bladder cancers were diagnosed in the VA’s healthcare system.
Specifically, according to a study in the journal Cancer, the deficit of new cancer diagnoses continued to accumulate throughout 2020. Compared to the baseline years, that resulted in an estimated:
- 11,362 fewer prostate cancers (23% of annual baseline),
- 2365 fewer lung cancers (13%),
- 2130 fewer bladder cancers (18%),
- 1,979 fewer colorectal cancers (20%).
“The coronavirus disease 2019 (COVID-19) pandemic caused disruptions in treatment for cancer,” wrote authors from the University of Maryland School of Medicine and the Baltimore VAMC. “Less is known about its impact on new cancer diagnoses, where delays could cause worsening long-term outcomes. This study quantifies decreases in encounters related to prostate, lung, bladder and colorectal cancers, procedures that facilitate their diagnosis, and new diagnoses of those cancers in the COVID era compared to pre-COVID era.”1
The study team reviewed all encounters at VA facilities nationwide from 2016 through 2020 and quantified trends in new diagnoses of cancer and in procedures facilitating their diagnosis, from Jan. 1, 2018, onward.
Researchers reported that, from 2018 through 2020, there were 4.1 million cancer-related encounters, 3.9 million relevant procedures and 251,647 new cancers diagnosed.
“Compared to the annual averages in 2018 through 2019, colonoscopies in 2020 decreased by 45% whereas prostate biopsies, chest computed tomography scans, and cystoscopies decreased by 29%, 10%, and 21%, respectively. New cancer diagnoses decreased by 13% to 23%. These drops varied by state and continued to accumulate despite reductions in pandemic-related restrictions.”
The authors concluded that disruptions due to the COVID-19 pandemic have led to significant reductions in diagnoses of new cancers at the VA and suggested, “There may be several reasons why the deficits have persisted even as states and institutions have relaxed COVID‐related restrictions. The variations in state‐level trends may reflect variations in statewide restrictions, institutional response to local outbreaks, or differences in perceived risk of COVID‐19 by patients and institutions.”
The study added that, “unemployment and the financial hardships from the pandemic may have restricted health care access, although not as significant a problem in the VA population as in employer‐based insurance. Perceived risks of invasive versus noninvasive procedures may explain why CT scans recovered to near baseline levels by the end of 2020 and accumulated smaller backlogs than colonoscopies. Even if the risks of COVID‐19 are minimized through vaccination and herd immunity, patients who have fallen out of the routine of their typical care may encounter barriers to re‐entry that are difficult to overcome. For these reasons, health systems will need to identify areas where patients are not following up on their routine cancer care or screening and find ways to reassure and re‐engage them.”
- Englum BR, Prasad NK, Lake RE, Mayorga-Carlin M, Turner DJ, Siddiqui T, Sorkin JD, Lal BK. Impact of the COVID-19 pandemic on diagnosis of new cancers: A national multicenter study of the Veterans Affairs Healthcare System. Cancer. 2022 Mar 1;128(5):1048-1056. doi: 10.1002/cncr.34011. Epub 2021 Dec 6. PMID: 34866184; PMCID: PMC8837676.