Diagnosing Cancer During The Covid-19 Pandemic: A Retrospective Cohort Study From A Public Safety Net Referral Institution

Objectives: The goal of this study was to compare the number of new, solid malignancy diagnoses at a single, public safety-net referral institution before and after the issuance of a statewide COVID-19 stay-at-home order. Methods: Patients with a new diagnosis of solid malignancy between 9/25/2019 and 9/9/2020 were identified by querying pathology reports for ‘carcinoma,’ ‘sarcoma,’ or ‘lymphoma.’ Patients under 18 years and those with recurrent cancers were excluded. New cancer diagnoses were then compared in two cohorts. The exposure cohort (‘Post-COVID-19’) included all patients with new, solid malignancy diagnoses from the first day of the mandated stay-at-home order in California, 3/19/2020, until 9/9/2020 (175 days). The control cohort (‘Pre-COVID-19’) included all patients with new, solid malignancy diagnoses during an equivalent time period before the statewide order, from 9/25/2019 until 3/18/2020 (175 days). Results: A total of 718 patients were found to have new histologic diagnoses of carcinoma, sarcoma, or lymphoma between 9/25/2019 and 9/9/2020. There were 409 patients diagnosed Pre-COVID-19 and 309 patients diagnosed Post-COVID-19, for an overall 24.44% decrease in the number of new, solid malignancy diagnoses (Table 1). There were 51 patients diagnosed with a new gynecologic malignancy Pre-COVID-19 compared to 37 patients Post-COVID-19, representing a 27.45% relative decrease in new diagnoses. Subgroup analysis of gynecologic malignancies revealed a 29.62 to 57.14% decrease in the number of new uterine, cervical and vaginal cancer diagnoses, while the number of new ovarian cancer diagnoses remained relatively stable. Conclusions: In our public safety net institution, which serves a largely non-White, 70% Latinx patient population, there has been a significant decrease in the total number of new, solid malignancy diagnoses since the start of COVID-19 pandemic. Of gynecologic malignancies, the impact has been most pronounced in uterine, cervical and vaginal cancer diagnoses. In contrast, new ovarian cancer diagnoses have remained relatively stable. This may be explained by the different ways each of these cancers presents. Uterine cancers typically present with abnormal bleeding, a symptom often perceived as tolerable and shared with many benign conditions, and may be missed if patients defer outpatient or emergency encounters. Cervical and vaginal cancers are most often identified through outpatient screening practices, and may be missed if in-person clinic encounters are deferred. The relatively stable number of ovarian cancer diagnoses likely reflects the lack of screening and the significant symptom burden common at time of diagnosis, leading patients to seek care even during the pandemic. The results of this study indicate that delaying routine cancer screening and work-up for potential early cancer symptoms, as a result of the COVID-19 pandemic, is diminishing our ability to presciently diagnose cancer. The goal of this study was to compare the number of new, solid malignancy diagnoses at a single, public safety-net referral institution before and after the issuance of a statewide COVID-19 stay-at-home order. Patients with a new diagnosis of solid malignancy between 9/25/2019 and 9/9/2020 were identified by querying pathology reports for ‘carcinoma,’ ‘sarcoma,’ or ‘lymphoma.’ Patients under 18 years and those with recurrent cancers were excluded. New cancer diagnoses were then compared in two cohorts. The exposure cohort (‘Post-COVID-19’) included all patients with new, solid malignancy diagnoses from the first day of the mandated stay-at-home order in California, 3/19/2020, until 9/9/2020 (175 days). The control cohort (‘Pre-COVID-19’) included all patients with new, solid malignancy diagnoses during an equivalent time period before the statewide order, from 9/25/2019 until 3/18/2020 (175 days). A total of 718 patients were found to have new histologic diagnoses of carcinoma, sarcoma, or lymphoma between 9/25/2019 and 9/9/2020. There were 409 patients diagnosed Pre-COVID-19 and 309 patients diagnosed Post-COVID-19, for an overall 24.44% decrease in the number of new, solid malignancy diagnoses (Table 1). There were 51 patients diagnosed with a new gynecologic malignancy Pre-COVID-19 compared to 37 patients Post-COVID-19, representing a 27.45% relative decrease in new diagnoses. Subgroup analysis of gynecologic malignancies revealed a 29.62 to 57.14% decrease in the number of new uterine, cervical and vaginal cancer diagnoses, while the number of new ovarian cancer diagnoses remained relatively stable. In our public safety net institution, which serves a largely non-White, 70% Latinx patient population, there has been a significant decrease in the total number of new, solid malignancy diagnoses since the start of COVID-19 pandemic. Of gynecologic malignancies, the impact has been most pronounced in uterine, cervical and vaginal cancer diagnoses. In contrast, new ovarian cancer diagnoses have remained relatively stable. This may be explained by the different ways each of these cancers presents. Uterine cancers typically present with abnormal bleeding, a symptom often perceived as tolerable and shared with many benign conditions, and may be missed if patients defer outpatient or emergency encounters. Cervical and vaginal cancers are most often identified through outpatient screening practices, and may be missed if in-person clinic encounters are deferred. The relatively stable number of ovarian cancer diagnoses likely reflects the lack of screening and the significant symptom burden common at time of diagnosis, leading patients to seek care even during the pandemic. The results of this study indicate that delaying routine cancer screening and work-up for potential early cancer symptoms, as a result of the COVID-19 pandemic, is diminishing our ability to presciently diagnose cancer.