Disruptions in Lung Cancer Detection During COVID-19

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• The COVID-19 pandemic has impacted healthcare access and delivery globally.
• Disruptions in cancer screening and diagnosis may have led to delayed detection and worse outcomes.

Purpose of the Study:

• To quantify the impact of the COVID-19 pandemic on lung cancer detection rates.
• To examine disparities in lung cancer diagnosis across demographic and community factors during the pandemic.
• To assess the recovery of lung cancer detection in the initial two years of the pandemic.

Main Methods:

• Retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database (2001-2021).
• Projected expected lung cancer incidence rates for 2020-2021 based on pre-pandemic trends (2000-2019) using Joinpoint Regression.
• Calculated percent differences between expected and observed incidence; conducted multivariate and propensity score analyses for metastatic disease diagnosis odds.

Main Results:

• Lung cancer incidence decreased by 10% in 2020 compared to projections, disproportionately affecting rural populations, non-Hispanic Black and Asian patients, and females.
• By 2021, detection rates partially recovered but remained 5% below expected levels, with localized disease detection improving.
• Rural, non-metropolitan communities experienced further declines; small-cell lung cancer (SCLC) patients and minority ethnic groups showed persistently higher rates of distant disease presentation through 2021.

Conclusions:

• The pandemic caused a significant reduction in lung cancer detection, with incomplete recovery by 2021.
• Persistent disparities in detection and diagnosis were observed, particularly in rural and minority populations.
• Targeted interventions are crucial to re-engage underserved communities and mitigate long-term impacts on lung cancer outcomes.