Delayed, Inaccessible Care Led to Higher Rates of Cancer Deaths During Pandemic

Nearly 20,000 cancer-related deaths in the United States might have occurred in 2020 because medical care was delayed. Healthcare capacity was challenged by the pandemic, limiting access to care for patients with cancer, according to a recent report. Find out how researchers quantified the effect.

ATLANTA -- The COVID-19 pandemic increased the number of cancer-related deaths by 3.2% in the United States from 2019-2020, according to a report from the American Cancer Society, which suggest that delayed care was the primary reason.

The study presented at the recent American Society of Clinical Oncology meeting, points out that, compared to 2019, the monthly cancer-related mortality rate was higher in April 2020, when healthcare capacity was most challenged by the pandemic. The researchers note that mortality rates also were higher each month from July to December 2020 compared to 2019.

“The coronavirus disease 2019 (COVID-19) pandemic resulted in delayed medical care that may have led to increased death rates in 2020 among people with medical conditions such as cancer,” according to background information in the article.

To identify cancer-related deaths, Jingxuan Zhao, MPH, senior associate scientist, health services research at the American Cancer Society, and colleagues used the U.S. 2019-2020 Multiple Cause of Death database from the national Centers for Disease Control and Prevention WONDER. Cancer deaths were defined as those involving invasive cancer as a contributing cause of death. T

The study team compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020, during the pandemic, vs. January-December 2019, before the pandemic. Results were stratified by rurality and place of death. The 2020 excess death was calculated by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rates from 2015 to 2019.

Results indicate that the number of cancer-related deaths was 686,054 in 2020, up from 664,888 in 2019, with an annual increase of 3.2%. The number of projected deaths for 2020 was 666 286, with the number of cancer-related excess deaths totaling 19,768.

“Annual age-standardized cancer-related mortality rate (per 100,000 person-years) continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020 (2020 vs 2019 rate ratio (RR): 1.013, 95% confidence interval (CI): 1.009 - 1.016),” the authors report. “The cancer-related monthly mortality rate was higher in April 2020 (RR: 1.032, 95% CI: 1.020 – 1.044) when healthcare capacity was most challenged by the pandemic, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019.”

Specifically, the researchers advise that, in large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020; that matches the time-spatial pattern of COVID-19 incidence in the country, they explain.

Another finding was that, compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in the homes of patients who died.

“The COVID-19 pandemic led to significant increases in cancer-related deaths in 2020 versus 2019,” the study concludes. “Ongoing evaluation of the spatial-temporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.”