By Christopher Cheney
Decreased rates of cancer screening during the coronavirus pandemic could lead to a significant increase in cancer mortality, a cancer expert says.
People have been deferring care during the pandemic due to fear of contracting the coronavirus in healthcare settings. For five kinds of cancer, reduced cancer screening linked to the coronavirus pandemic has likely led to thousands of delayed cancer diagnoses, according to an IQVIA Institute report. For the three-month period ending June 5, 2020, the IQVIA Institute estimates there could have been more than 80,000 delayed positive diagnoses for breast, cervical, colorectal, lung, and prostate cancer.
Delays in cancer diagnoses lead to increases in cancer mortality, says Justin Klamerus, MD, president of Karmanos Cancer Hospital and Network, a division of the Karmanos Cancer Institute in Detroit. Karmanos facilities are owned by McLaren Health Care—a health system based in Grand Blanc, Michigan.
“The earlier stage that a cancer is diagnosed, the greater the likelihood that it can be cured. If you look at breast cancer, before the pandemic 92% of women who were diagnosed with breast cancer could be expected to be cured. That number is directly correlated to the stage of diagnosis. If you have a Stage 3 breast cancer with a large mass that has grown over time, there is a lower chance of survival. With a large mass, there is a higher chance of spread to lymph nodes and a higher chance of distance spread to other organs. When breast cancer spreads to other organs, it becomes incurable,” Klamerus says.
Prevention is the No. 1 goal in cancer care, but screening is crucial, he says. “When we cannot prevent a cancer, identifying and diagnosing at the earliest stage in almost every cancer leads to a higher likelihood of a cure.”
In the Karmanos network, screenings for all cancers were down 17.2% in the fiscal year ending October 2020 compared to the 2019 fiscal year. Mammograms were down 16.8% and colonoscopies were down 20.4%. Roughly 107,000 patients were screened for these cancers at Karmanos in 2019, versus 89,000 in 2020.
The early signs of the impact of decreased screening are troubling, Klamerus says. “Anecdotally, what we are seeing is that patients are presenting with more advanced stages of disease. They are avoiding symptoms that would normally lead to having tests done or seeing a doctor. Patients are avoiding that care because of the concerns over COVID-19.”
Klamerus fears that the decrease in cancer screening linked to the coronavirus pandemic will lead to a significant increase in cancer mortality.
“For many decades, we saw that the death rates from cancer were increasing every year. In 2016, we saw cancer death rates fall for the first time and every year thereafter it had fallen. Many of us in cancer medicine are concerned that because of the pandemic, 2020 will be a year when we see that positive trend reverse and we will see an increase in cancer death rates because of individuals avoiding screening and seeing their physicians,” he says.
The decrease in cancer screenings is part of a distressing national trend of deferred healthcare services during the pandemic, Klamerus says. “Deferred care is a second pandemic, which is not uncommon when you look at the history of pandemics.”
Encouraging cancer screening
Karmanos has used an “all-hands-on-deck approach” to encourage patients to undergo cancer screening, Klamerus says.
“First, we recognized that our physicians and providers who have relationships with patients needed to directly reach out to those patients. We have provided instructional materials that could be used with patients to encourage screening and to make sure patients knew that we were doing everything possible as an organization to be a safe place for care,” he says.
Karmanos has used multiple outreach channels to encourage screening, Klamerus says. “We did media campaigns through social media. We partnered with our McLaren Medical Group, which are our primary care physicians, to reinforce the importance of cancer screening.”
Karmanos also mobilized cancer navigators, who work in the organization’s cancer centers, he says. “We had those navigators work with our screening centers to try to identify patients who had missed screening and have direct contact with them. The navigators answered questions about concerns that patients had about accessing care and emphasized the safety of the care that was being provided at our facilities.”
Infection control efforts
Karmanos and McLaren have taken several steps to prevent coronavirus infections in care settings, Klamerus says. “First of all, we have worked to make sure that our buildings are safe.”
“You cannot get into our buildings unless you are screened for COVID-19 symptoms including a temperature check. We have limited visitors. We have aggressive cleaning of the patient rooms in clinic and ambulatory settings as well as our hospitals. We have ended practices such as semi-private rooms in inpatient settings—those are all private rooms now,” he says.
Karmanos and McLaren have also embraced technology to reduce possible coronavirus exposure. In addition to increasing the use of telemedicine visits, they have reduced traffic in their waiting rooms, Klamerus says. “We have adopted new queuing systems for waiting rooms. We keep people in the parking lot longer, contact them on their cell phones, and bring them into our buildings just before their appointments to limit crowding.”
Now, there is an emphasis on vaccination, he says. “We have had robust employee vaccination programs. As of January 6, we had 65% of our employees vaccinated, and we had two more waves of employee vaccinations in the two weeks after January 6. We are aiming to get as many people vaccinated as possible as we pivot from vaccinating frontline workers to getting patients and members of our community vaccinated.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.