Patients diagnosed as having cancer in the United States in 2020 and 2021 had significantly worse short-term survival than those diagnosed before the COVID-19 pandemic, according to a population-based cohort study published last week in JAMA Oncology.
Analyzing data from more than 1 million US patients diagnosed as having invasive cancer in 2020 and 2021, a team led by researchers from the University of Kentucky looked at the patients’ 1-year cause-specific survival (CSS) rates and compared them with those of cancer patients diagnosed from 2015 to 2019.
During the first two pandemic years, 1,008,012 people were diagnosed with cancer—473,781 in 2020 and 534,231 in 2021. Overall, one-year CSS was 84.8% in 2020 and 85.7% in 2021.
The researchers observed absolute reductions in one-year CSS for both early- and late-stage cancers. For early-stage diagnoses, survival was 0.44 percentage points lower than expected in 2020 and 0.27 percentage points lower in 2021 compared with survival trends for the same cohort from 2015 to 2019. For late-stage diagnoses, survival was 1.34 percentage points lower than expected in 2020 and 1.20 percentage points lower in 2021.
“In both years, 1-year CSS for late-stage cases was significantly lower than expected based on prepandemic survival trends,” the researchers write.
Those declines translated into an estimated 9,162 more cancer deaths within 1 year of diagnosis in 2020 and 8,228 in 2021, for a total of 17,390 more cancer-related deaths during the pandemic, which was 13.1% higher than expected.
Survival rates worse across all demographic groups
Decreases in short-term survival were seen across all observed demographic groups, with particularly large declines among adults aged 65 years or older and American Indian/Alaska Native and Asian/Pacific Islander populations with late-stage diagnoses. Absolute reductions in these groups exceeded one percentage point in both years.
The researchers also considered survival rates across different types of cancer, namely those with low survival rates and more-common cancers that traditionally have better outcomes. Harder-to-survive cancers showed higher one-year mortality rates during the pandemic. “It was not surprising to find that several cancer sites with traditionally low survival rates experienced greater-than-expected 1-year mortality associated with pandemic-related disruptions during 2020 and 2021,” they write.
Swift action should be taken to increase cancer screening, rebuild health care capacity, and improve patient communication.
At the same time, several high-survival cancers also saw significant drops in one-year survival rates. The survival declines were smaller, but because these cancers are more common, the higher incidence rate translated to a substantial increase in lost lives. Missed or delayed diagnoses, less-advanced or asymptomatic cases, delays in time to treatment, and treatment disruptions may help explain the drop in survival among more-common cancers in 2020 and 2021.
“Overall, our findings indicate that individuals diagnosed with cancer in the US during 2020 and 2021 experienced poorer cancer-related outcomes in the first year after diagnosis than those diagnosed before the COVID-19 pandemic,” write the researchers, noting that disruptions related to the pandemic had a substantial impact on cancer care. They recommend that “swift action should be taken to increase cancer screening, rebuild health care capacity, and improve patient communication to combat longer-term consequences and prepare for potential future disruptions.”
