Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors.
Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors.
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DOI：
10.1200/cci.20.00134
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发表时间：
2020-11
影响因子：
4.2
通讯作者：
Zhou A
中科院分区：
文献类型：
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作者：
Patt D;Gordan L;Diaz M;Okon T;Grady L;Harmison M;Markward N;Sullivan M;Peng J;Zhou A
虽然与COVID-19大流行相关的即时护理和获取中断在某些地区受到越来越多的关注，但在全国范围内，癌症筛查和治疗方面的各种差距尚未得到充分了解或全面记录。本研究使用了一个大型医疗索赔信息交换中心数据库，该数据库代表了5%-7%的医疗保险按服务收费人群，以表征癌症护理服务利用的变化，并深入了解COVID-19对美国癌症人群的影响，包括新患者的识别、获得护理的差距和治疗旅程的中断。2020年3月至7月，与2019年3月至7月的基线期相比，癌症筛查、就诊、治疗和手术的数量大幅减少，因癌症类型和服务地点而异。在4月大流行高峰期，乳腺癌、结肠癌、前列腺癌和肺癌的筛查率分别下降了85%、75%、74%和56%。4月份，医院门诊评估和管理（E&M）访问量（- 74%）、新患者E&M访问量（- 70%）和已建立患者E&M访问量（- 60%）的利用率显著下降。顶级医生管理的肿瘤产品的计费频率下降，在4月（- 26%）和7月（- 31%）均下降。乳房切除手术在4月到7月持续减少，结肠切除手术在4月和5月也同样减少，前列腺切除手术在4月和7月下降。目前，COVID-19大流行对美国癌症护理的影响导致新癌症的发现和治疗的提供减少和延迟。这些问题如果得不到缓解，将在未来几年增加癌症发病率和死亡率。
While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.