A new American Cancer Society (ACS) report has found that mortality rates with cancer as a contributing factor were higher in 2020 -- the first year of the COVID-19 pandemic -- compared with prepandemic 2019 rates.
This trend appears to be due in part to the delay of nonemergency treatment that happened as the COVID-19 crisis began, noted a team led by Jingxuan Zhao of the ACS. The findings were published April 11 in the Journal of Oncology Practice.
"The stay-at-home orders and the discontinuation of nonemergency treatment to limit hospital capacity and reduce transmission at the beginning of the pandemic may have resulted in delayed cancer screenings, diagnoses, and treatments, and possibly contributed to increased mortality," Zhao said in a statement released by the ACS.
In contrast, deaths caused by cancer as the primary cause decreased during 2020 -- continuing an existing trend.
Since the first case of COVID-19 was confirmed in January 2020, almost 100 million cases and one million deaths have been documented around the world, Zhao and colleagues noted. People with cancer are not only more vulnerable to contracting COVID-19 but also to developing a more severe form of it.
But although studies have explored the vulnerability of cancer patients to COVID-19, there's little research about how the disease may affect cancer-related deaths. To address this knowledge gap, Zhao and colleagues conducted a study that used data from the 2015 to 2020 Underlying and Multiple Cause of Death, which is part of the Centers for Disease Control and Prevention's (CDC) Online Data for Epidemiological Research (WONDER) database and is produced by the National Center for Health Statistics.
The investigators found that the pandemic reduced the number of deaths caused by cancer as an underlying cause but increased the number of deaths caused by cancer as a contributing factor.
| Number and nature of cancer-related deaths, 2019 and 2020 | ||
| Metric | January to December 2019 (prepandemic) | January to December 2020 (first year of pandemic) |
| Number of deaths with cancer as underlying cause | 599,601 | 602,350 |
| Death rate with cancer as underlying cause (per 100,000 person-years) | 146.2 | 144.1 |
| Number of deaths with cancer as contributing cause | 664,888 | 686,054 |
| Death rate with cancer as contributing cause (per 100,000 person-years) | 162 | 164.1 |
The team also found that monthly death rates with cancer as a contributing cause began to increase in April 2020, dipped in May and June of that year, and increased each month from July to December 2020 compared to 2019, with the highest ratio in December.
What do the findings suggest? That the effects of events like the COVID-19 pandemic need to be tracked, according to Zhao's team.
"Our findings suggest that ongoing evaluation of the ... effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns of vaccine and booster uptake and COVID-19 hospitalization rates," the group concluded.
