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Oncology

Disruption of National Cancer Database Data Models in the First Year of the COVID-19 Pandemic

To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: April 12, 2023

Special Communication

Article Information and Disclosures

Sharon S. Lum, MD, MBA¹;

Amanda E. Browner, MS²;

Bryan Palis, MA²;

Heidi Nelson, MD²;

Daniel Boffa, MD, MBA³;

Leticia M. Nogueira, PhD, MPH⁴;

Vicki Hawhee, MEd, CTR⁵;

Ryan M. McCabe, PhD²;

Timothy Mullett, MD, MBA⁶;

Elizabeth Wick, MD⁷

Author Affiliations

¹Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
²American College of Surgeons Cancer Programs, Chicago, Illinois
³Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
⁴Surveillance and Health Equity Sciences, American Cancer Society, Kennesaw, Georgia
⁵Baptist Health South Florida, Miami
⁶Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, Lexington
⁷Division of Surgical Oncology, University of California, San Francisco School of Medicine, San Francisco

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Abstract

Importance Each year, the National Cancer Database (NCDB) collects and analyzes data used in reports to support research, quality measures, and Commission on Cancer program accreditation. Because data models used to generate these reports have been historically stable, year-to-year variances have been attributed to changes within the cancer program rather than data modeling. Cancer submissions in 2020 were anticipated to be significantly different from prior years because of the COVID-19 pandemic. This study involved a validation analysis of the variances in observed to expected 2020 NCDB cancer data in comparison with 2019 and 2018.

Observations The NCDB captured a total of 1 223 221 overall cancer cases in 2020, a decrease of 14.4% (Δ = −206 099) compared with 2019. The early months of the COVID-19 pandemic (March-May 2020) coincided with a nadir of cancer cases in April 2020 that did not recover to overall prepandemic levels through the remainder of 2020. In the early months of the COVID-19 pandemic, the proportion of early-stage disease decreased sharply overall, while the proportion of late-stage disease increased. However, differences in observed to expected stage distribution in 2020 varied by primary disease site. Statistically significant differences in the overall observed to expected proportions of race and ethnicity, sex, insurance type, geographic location, education, and income were identified, but consistent patterns were not evident.

Conclusions and Relevance Historically stable NCDB data models used for research, administrative, and quality improvement purposes were disrupted during the first year of the COVID-19 pandemic. NCDB data users will need to carefully interpret disease- and program-specific findings for years to come to account for pandemic year aberrations when running models that include 2020.

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Article Information

Accepted for Publication: January 17, 2023.

Published Online: April 12, 2023. doi:10.1001/jamasurg.2023.0652

Corresponding Author: Sharon S. Lum, MD, MBA, Loma Linda University School of Medicine, 11175 Campus St, CP21111, Loma Linda, CA 92354 (slum@llu.edu).

Author Contributions: Dr Lum and Mr Palis had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Lum, Browner, Palis, Nelson, Nogueira, McCabe, Mullett, Wick.

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

Drafting of the manuscript: Lum, Browner, Palis, Nelson, Boffa, Wick.

Critical revision of the manuscript for important intellectual content: Lum, Browner, Palis, Nelson, Boffa, Nogueira, Hawhee, McCabe, Mullett.

Statistical analysis: Lum, Browner, Palis, Nogueira, Mullett.

Administrative, technical, or material support: Browner, Palis, Nelson, Hawhee, McCabe, Mullett.

Supervision: Lum, Nelson, McCabe.

Conflict of Interest Disclosures: Dr Boffa reported honoraria from Iovance outside the submitted work. Dr Wick reported grants from Agency for Healthcare Research and Quality outside the submitted work. No other disclosures were reported.

Additional Contributions: The authors wish to acknowledge the Commission on Cancer and National Cancer Database of the American College of Surgeons.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.