Study reports drop in lung cancer screening, rise in malignancy during COVID-19 surge
Findings may provide a potential framework for keeping up cancer care
through current surge of the pandemic

Date:
December 17, 2020
Source:
American College of Surgeons
Summary:
Reporting on how deferred care worsened outcomes for lung cancer
patients when the COVID-19 pandemic first surged in the spring of
2020, researchers explained that they have identified a framework
that could help people with serious health conditions keep up
their appointments during the current surge.



FULL STORY ==========================================================================
The current surge in coronavirus disease 2019 (COVID-19) cases poses
challenges for providers and institutions in delivering care to infected patients while also placing demands on them to keep up with timely and sometimes critical care for patients with cancer, heart disease and
other serious illnesses who might experience advanced complications
and/or earlier death if they have lapses in their care. Reporting
on how deferred care worsened outcomes for lung cancer patients when
the COVID-19 pandemic first surged in the spring of 2020, researchers
from the University of Cincinnati explained that they have identified
a framework that could help people with serious health conditions keep
up their appointments during the current surge.


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The study has been selected for the 2020 Southern Surgical Association
Program and published as an "article in press" on the Journal of the
American College of Surgeons website in advance of print.

The researchers compared monthly visits for low-dose computed tomography
(LDCT) screening for lung cancer during the three months in which
COVID-19 restrictions were in place with the number of monthly visits
from the three years before that. LDCT is an imaging modality known to
reduce mortality from lung cancer by at least 20 percent in high-risk
patients. The institution suspended LDCT on March 13 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, an assistant professor and thoracic surgeon at the University of Cincinnati College of Medicine and a member of Cincinnati Research in
Outcomes and Safety in Surgery (CROSS) within the department of surgery.

The institution averaged 146 LDCT tests a month before COVID-19 compared
with 39 in March to June this year (p<0.01), with new patient monthly
averages falling from 56 to 15 (p<0.01).

"Also when we resumed our operations, we found that new patients were less likely to come back to our screening program," Dr. Van Haren added. They reported that new patient monthly LDCT rates have remained low despite
resuming full operations.



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"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," Dr. Van Haren said. The no-show rate went from 15 percent before the COVID-19 restrictions to 40 percent afterward (p<0.04).

Further, when full operations resumed in June, 29 percent of patients
were found to have lung nodules suspicious for malignancy compared with
8 percent in the pre-COVID-19 period (p<0.01). That meant more patients
were referred to a specialist for either biopsy or surgery as their
suspected cancer entered a more critical phase.

These poor rates of screening probably reflect patient fears about coming
into the hospital during the pandemic, although the study did not look
at that concern specifically, Dr. Van Haren said.

"We've done two things to try to deal with that situation," Dr. Van
Haren said.

"One was that we made operational changes to ensure that screening is
safe, and we made a big emphasis within our program and with our nurses
and coordinators to educate patients about those changes and to really
get the message out that screening is safe." The key operational change
was shifting the setting for the LDCT from the hospital to an outpatient center, but other changes included enforcing social distancing in the
waiting rooms and in the scanning areas, and spacing appointments farther
apart to allow for appropriate cleaning of those areas.

"Our results are important and suggest that it's critical to continue
cancer screening operations, such as our lung cancer screening, during
this pandemic," Dr. Van Haren said. "It's maybe more important now as
we continue to undergo another surge of COVID-19 cases throughout the
country." He added, "We have to make sure as health care providers
that we're taking care of patients who have COVID-19 and along with
the rest of the population who don't have COVID-19, and that those
two patient populations can safely co-exist and receive treatment."
In an invited commentary, William B. Weir, MD, and Andrew C. Chang,
MD, FACS, of Michigan Surgery, Ann Arbor, wrote, "We must find a way to continue routine oncologic care or the true COVID-19 mortality rate will
begin to include advanced stages of lung cancer." Study coauthors are
Aaron M. Delman, MD, Kevin M. Turner, MD, Shimul A. Shah, MD, FACS, and
Sandra L. Starnes, MD, FACS, of the Cincinnati Research in Outcomes and
Safety in Surgery, department of surgery at the University of Cincinnati College of Medicine; and Brandy Waits, RN, and Mona Hemingway, RN, of
the division of thoracic surgery. Dr. Starnes is also with the division
of thoracic surgery.


========================================================================== Story Source: Materials provided by American_College_of_Surgeons. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Robert M. Van Haren, Aaron M. Delman, Kevin M. Turner, Brandy
Waits, Mona
Hemingway, Shimul A. Shah, Sandra L. Starnes. Impact of the
COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent
Lung Cancer.

Journal of the American College of Surgeons, Dec. 17, 2020; DOI:
10.1016/ j.jamcollsurg.2020.12.002 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/12/201217113000.htm

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