NCCN and ACS Call for Resumption of Cancer Screening, Treatment Amidst COVID-19 Crisis

Robert W. Carlson, MD

The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) are collaborating with cancer organizations nationwide to promote the resumption of cancer screening and treatment during the coronavirus disease 2019 (COVID-19) pandemic.¹

“When cancer is caught earlier, it is typically easier to treat because there are more options available. When the pandemic first hit the United States, a short delay in care was an appropriate choice for many cancer types,” Robert W. Carlson, MD, CEO of NCCN, stated in a press release. “However, the balance of risk has shifted significantly. We now have 2 impressive vaccines that are being distributed around the world. We also know much more about how to treat and prevent COVID-19. Cancer centers are taking multiple measures to protect patients and staff from COVID-19 and transmission within cancer centers is quite unusual. Meanwhile, far too many cancers are being left to grow unchecked. Postponing cancer care will add tragedy on top of tragedy.”

The coalition, comprised of 76 organizations including Penn Medicine, Dana-Farber Cancer Institute, Duke Cancer Institute, and Huntsman Cancer Institute, issued a letter to the public to serve as a reminder that cancer still represents a major threat, and taking action as soon as is safety feasible can result in better outcomes for those afflicted by this disease.²

In the letter, they note that the number of people newly diagnosed with cancer has significantly decreased in the United States and other countries worldwide during the pandemic.^3,4 For example, results from 1 cross-sectional study of patients in the United States who received testing for any cause between January 1, 2018, to April 18, 2020, showed that the weekly number of cancer cases identified fell by 46.4%, going from 4310 to 2310.2 Significant declines in all cancer types evaluated were noted, ranging from 24.7% for pancreatic cancer to 51.8% for breast cancer.

“These distressing trends tell us that many cancers are going undiagnosed and untreated in the wake of COVID-19,” they write in the letter. “As leading cancer centers and organizations, we urge people across the country to talk with their health care provider to resume regular primary care check-ups, recommend cancer screening, and evidence-based cancer treatment to lessen the negative impact the pandemic is having on identifying and treating people with cancer.”

In another study, investigators utilized a large medical claims clearinghouse database that accounted for 5% to 7% of the Medicare fee-for-service population to describe changes in the use of cancer care services and glean additional insight on the impact of the pandemic on patients with cancer.⁵ When comparing data from March 2019-July 2019 with March 2020-July 2020, they noted a substantial decrease in cancer screenings, visits, therapy, and surgeries, which varied by cancer type and site of service. Specifically, at the peak of the pandemic, which was identified to be April 2020, screenings decreased by 85% for breast cancer, 75% for colon cancer, 74% for prostate cancer, and 56% for lung cancer.

Additionally, data from the Epic Health Research Network revealed a decrease of 86% to 94% in cancer screenings performed nationwide in 2020 compared with equivalent weeks from 2017 and 2019.⁶ Here, cervical screenings saw a 94% reduction, while screenings for colorectal cancer (CRC) dropped by 86% versus the same time period in the years prior.

“The National Cancer Institute conservatively predicted almost 10,000 excess deaths in the United States from breast and CRC alone because of pandemic-related delays in cancer screening and treatment,”⁷ they wrote in the letter. “However, this estimate does not account for other cancer types and assumed only a 6-month disruption in care, suggesting the actual excess deaths could be much higher.”

In response to the pandemic, hospitals and medical systems nationwide and globally have launched countless efforts to prevent unnecessary exposure to the virus and have taken the necessary infection control measures to continue to provide patients with cancer a safe environment to receive medical care during the pandemic.

In the letter, the coalition recommends the following:

• Ensure communities are not delaying care for important medical issues
• Encourage those within the community to continue to recommend cancer screening
• Expedite and encourage patients with cancer to continue to receive evidence-based treatment for their disease
• Encourage patients to contact their physicians immediately if any concerning effects present
• Patients resume all preventive and prescribed care, including regular cancer screening

“Advances in cancer screening and treatment have resulted in a significant decline in the annual death rate from cancer,” they conclude. “We must not lose our momentum now. Please join us and help people across America re-engage in cancer screening and care—their lives may depend upon it.”

References

1. Leading cancer organizations warn cancer doesn’t stop for COVID-19 and neither should you. News release. The National Comprehensive Cancer Network and American Cancer Society. January 28, 2021. Accessed January 28, 2021. http://prn.to/2MbURqN.
2. Major US cancer centers and organizations endorse goal of resuming cancer screening and treatment during the COVID-19 pandemic. The National Comprehensive Cancer Network and American Cancer Society. January 28, 2021. Accessed January 28, 2021. https://bit.ly/3crZmbg.
3. Kaufman HW, Chen Z, Niles J, et al. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open. 2020;3(8):e2017267. doi:10.1001/jamanetworkopen.2020.17267
4. Coronavirus has a massive impact on cancer care. Bloomberg Opinion. June 15, 2020. Accessed January 28, 2021. http://bloom.bg/3qVb7uQ.
5. Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform. Published online November 4, 2020. doi:10.1200/CC.20.00134
6. Printz C. Cancer screenings decline significantly during pandemic. Cancer. 126(17):3894-3895. doi:10.1002/cncr/33128
7. Sharpless NE. COVID-19 and cancer. Science. 2020;368(6497):1290. doi:10.1126/science.abd3377