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Cancer Screening Tests and Cancer Diagnoses During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Oncology patient care may be disrupted secondary to coronavirus disease 2019 (COVID-19) through delays in diagnostic investigations and surgical procedures, as well as delayed cancer diagnoses because of reduced cancer screening. This study assesses the number of patients undergoing cancer screening tests and of ensuing cancer diagnoses during the COVID-19 pandemic in the largest health care system in the northeastern United States, Massachusetts General Brigham.

This study comprised four 3-month periods. One period, during the first peak of the pandemic in the New England area of the United States (from March 2 to June 2, 2020),1 was compared with 3 control periods before and after the main study period (the preceding 3 months from December 1, 2019, to March 2, 2020; the same 3 months in the preceding year from March 2 to June 2, 2019; and the 3 months after the main study period from June 3 to September 3, 2020). The percentage decrease in screening tests and in diagnoses during the pandemic period compared with each of the control periods was computed as percentage decrease = (Npandemic − Ncontrol)/Ncontrol. The 95% CIs were computed using the Clopper-Pearson method using the DescTools package in R. All analyses were performed using R, version 3.6.1 (R Foundation for Statistical Computing) (eMethods in the Supplement). Ethical approval for the study was provided by Brigham and Women’s Hospital prior to commencement of data analysis, including a waiver of the requirement for individual patient consent given the retrospective and noninterventional nature of the research.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 3, 2020.

Published Online: January 14, 2021. doi:10.1001/jamaoncol.2020.7600

Corresponding Authors: Toni K. Choueiri, MD, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215 (toni_choueiri@dfci.harvard.edu); Quoc-Dien Trinh, MD, Center for Surgery and Public Health, Brigham and Women’s Hospital, 75 Francis St, Boston, MA (qtrinh@bwh.harvard.edu).

Author Contributions: Drs Bakouny and Paciotti had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Bakouny, Paciotti and Schmidt are co–first authors. Drs Choueiri and Trinh are co–senior authors.

Concept and design: Bakouny, Schmidt, Lipsitz, Choueiri, Trinh.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Bakouny, Paciotti, Schmidt, Lipsitz.

Critical revision of the manuscript for important intellectual content: Bakouny, Schmidt, Lipsitz, Choueiri, Trinh.

Statistical analysis: Bakouny, Paciotti, Schmidt, Lipsitz.

Obtained funding: Choueiri.

Administrative, technical, or material support: Schmidt, Choueiri.

Supervision: Choueiri, Trinh.

Conflict of Interest Disclosures: Dr Bakouny reported receiving grants from Genentech/IMCore and nonfinancial support from Bristol Myers Squibb outside the submitted work. Dr Schmidt reported receiving nonfinancial support from Astellas and Pfizer outside the submitted work. Dr Choueiri reported receiving nonfinancial support from the COVID-19 and Cancer Consortium during the conduct of the study and personal fees from Pfizer, Exelixis, Bristol Myers Squibb, Merck, Roche/Genentech, and Novartis related to kidney cancer for clinical trials, to being on advisory boards, to consultancy, and to manuscript support outside the submitted work. Dr Trinh reported receiving personal fees from Astellas, Bayer, and Janssen and grants from Intuitive Surgical outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Trinh is supported by a Health Services Research pilot test grant from the Defense Health Agency and an unrestricted educational grant from the Vattikutti Urology Institute.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Mass.gov. Archive of COVID-19 cases in Massachusetts. Accessed October 25, 2020. https://www.mass.gov/info-details/archive-of-covid-19-cases-in-massachusetts
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