New results show that the number of reported cancer cases in the National Cancer Database during the COVID-19 pandemic declined by 14.4 percen, which means over 200,000 cancer cases were not diagnosed and/or treated.

The reasons were unclear, perhaps concern about catching COVID-19 or being symptomatic but not wanting to go to the doctor because of media claims about those unable to get care for SARS-CoV-2. The results are more obvious; a lot of people are at greater risk. 

According to the National Center for Health Statistics, 1.1 million died due to COVID-19 or complications, but counting deaths related to not going to the doctor because of concern will be more challenging. Researchers reviewed 4,045,097 cancer cases from adults 18 years or older who were diagnosed with cancer and/or received their first-course treatment at a reporting facility from January 1, 2018, through December 31, 2020. Reporting facilities included CoC-accredited programs, excluding Veterans Affairs-affiliated programs.

Among the key findings:

The COVID-19 pandemic was associated with significant changes in diagnoses of all cancer types in 2020, with a 14.4% overall decline in the number of reported cancer cases in the NCDB compared with the prior year. This decline represents more than 200,000 cancer cases that were not diagnosed and/or treated at CoC facilities.

These missing cancer cases are expected to appear in 2021 data and beyond, potentially at more advanced stages.

Overall, the proportion of patients diagnosed with early-stage disease decreased from March to June 2020, followed by a corresponding increase in the proportion of those diagnosed with late-stage disease, peaking in April 2020 and correcting to prior years’ percentages by July 2020. However, the 2020 stage distributions for specific types of cancer varied.

The study identified differences across sociodemographic data. Overall, the proportion of White patients with cancer significantly increased, while the proportion of Asian or Pacific Islander, Hispanic, Black, and other/unknown patients with cancer significantly decreased. This finding suggests that certain racial and ethnic groups were less likely to be diagnosed with cancer and/or receive cancer care, potentially exacerbating existing health disparities in cancer treatment.

Significant disparities were noted between age groups, with increases in cancer rates in people 60 to 69 years old and 70 to 79 years old, and decreases in age of diagnosis in younger and older age categories throughout 2020. This finding suggests that patients younger than 60 and those older than 80 were less likely to be diagnosed or treated for cancer compared with past years.

Because significant variance was identified in 2020 NCDB data compared with prior years, the authors recommend that centers publishing information with NCDB data include the following disclaimer language in publications using 2020 NCDB data: “This study includes data from the year 2020, the first year of the COVID-19 pandemic. Variability in reporting 2020 cases in the NCDB must be considered when interpreting results.”