, MD — Analysis of VA’s Electronic Records Reveals Disruption of Screenings and New Diagnosis.
A new study, conducted by Dr. Brajesh K. Lal, a vascular surgeon and researcher at the VA Maryland Health Care System’s Baltimore VA Medical Center, and professor of surgery at the University of Maryland School of Medicine (UMSOM), and his team found that the COVID-19 pandemic was associated with reductions in cancer screening and diagnostic procedures that likely resulted in a reduction in new cancer diagnoses. Study findings are now published by Wiley, a leader in research and education, and the American Cancer Society in the peer-reviewed journal CANCER’s forthcoming issue.
“Although more than 600,000 people have died directly from COVID-19, we also must be cognizant of the indirect losses occurring throughout the pandemic due to undiagnosed and untreated diseases such as cancer,” said Thomas Hornyak, MD, PhD., associate chief of staff for Research & Development at VA Maryland Health Care System and associate professor and chair of the Dermatology Department at the USMOM. “Dr. Lal and his research team examined the data and have brought to our attention one aspect of the pandemic’s indirect fallout on cancer screening and cancer diagnosis,” added Dr. Hornyak, who is also the Dr. Joseph Warren Burnett Professor in Dermatology at UMSOM.
Funded by an award from VA’s Health Services Research & Development Service, the team, led by Lal, examined data from the electronic medical records of VA Medical Centers nationwide and found reductions in patient visits related to cancer, in diagnostic or screening procedures that would detect an unsuspected cancer, and a corresponding reduction in diagnosis of the top four cancers seen within the VA system (colorectal, prostate, bladder and lung). This has significant implications since reduced detection will likely portend delayed presentation of these cancers in more advanced stages, with consequent worse outcomes for patients. They focused on data from 2018 through 2020 and found that 3.9 million procedures were used to diagnose 352,647 new cancer cases, with the number of screenings decreasing during the pandemic. Findings also indicate that procedures to diagnose cancers occurred less frequently in 2020, and also counted fewer new diagnosis of cancer in 2020, varying by geographic location and type of cancer. New cancer diagnoses in 2020 decreased by 13% to 23%, depending on the type of cancer. Using pre-COVID baseline data of Jan.1, 2018 to Dec. 31, 2019 and accounting for seasonal variations, the investigators calculated the deficit of monthly and annual rates from Jan. 1, 2020 to Dec. 31, 2020. They found that rates varied by location and cancer type with colonoscopies showing the largest decrease, resulting in an estimated deficit of 24,871 unperformed procedures in 2020, followed by a 29% decrease in prostate biopsies. The decrease in procedure rates occurred in both large and small states. Researchers created a chart that can be used by institutions, health systems, and states to determine time and resources required to increase the screening rates to recover from the pandemic induced backlog.
“The disruption in non-emergency health care during the peak of the pandemic was intentional and necessary,” said Lal who is also director of the UMSOM Center for Vascular Research. “As we enter the recovery phase, we hope that our work will help physicians, hospitals, and healthcare organizations anticipate the extent to which they have fallen behind in their efforts to diagnose new cancers. It will also help them allocate requisite resources and time to re-engage with patients.”
In the study, the seven-member team of VA clinicians, who also hold joint appointments at the University of Maryland School of Medicine, provided a means for facilities nationwide to devise a recovery plan to resolve unmet health care needs and avoid continuing fallout for potential worse outcomes for cancer patents, despite the backlog caused by the pandemic.
“We are proud of our robust research and development footprint with its $21.7 million annual budget” said Jonathan Eckman, PE, director of the VA Maryland Health Care System. “This study team is part of a group of 125 principle investigators focused on work aimed to improve the lives of veterans and subsequently, the lives of all Americans.”
“This critically important study speaks to the value of our faculty’s partnership with the VA and their funding for research that can be applied to patients nationwide,” said E. Albert Reece, MD, PhD, MBA, executive vice president for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “We must ensure that any delays in vital cancer screenings due to the COVID pandemic are rectified in order to get patients diagnosed as soon as possible, which will ultimately save lives.”