- This study examined cancer-related CT utilization at Massachusetts General Hospital and three affiliated community hospitals during the March to May 2020 peak of COVID-19 and a post-peak period extending into November 2020
- During the COVID-19 peak, CT volumes for all oncological imaging indications decreased significantly, with cancer screening and diagnostic workup volumes declining more than 50%
- CT volumes during the peak remained level in solo community hospitals and emergency departments (EDs), settings that are often unsuited to the complex medical needs of cancer patients
- After the peak, imaging for active cancer and cancer surveillance recovered to pre–COVID-19 levels, but cancer screening and diagnostic workup volumes did not fully recover (down 12% and 20% from baseline, respectively)
- For future health crises, systems should plan how to retain cancer-related CT at centers equipped to manage complex oncology cases, not at resource-limited hospitals or in the ED
By March 2020, hospitals worldwide were modifying care for cancer patients, who are at high risk of severe COVID-19. At Massachusetts General Hospital, cancer-related CT imaging was affected differently across indications, care settings and hospital type, according to a report in Cancer Medicine.
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Authors Marc D. Succi, MD, an emergency radiologist in the Department of Radiology, Ottavia Zattra, of the same department, and colleagues join those who predict surges of new and more advanced cancer diagnoses in upcoming months and years because of delays in care and inconsistent recovery of care delivery.
The researchers analyzed 23,855 cancer-related CT scans performed in 2020:
- Baseline period, pre–COVID-19 (January 5 to March 14)
- COVID-19 peak in Massachusetts (March 15 to May 2)
- Post-peak (May 3, when normal imaging operations resumed, to November 14)
During the Peak
Overall, the weekly volume of cancer-related CTs declined 42% from baseline. Screening CTs plummeted by 82%, initial workup CTs by 55%, active cancer CTs by 31% and surveillance CTs by 45% (P<0.0001 for all comparisons).
Volumes decreased significantly in the outpatient and inpatient settings but not in emergency departments. The two solo community hospitals studied retained stable volumes across indications.
The overall volume of cancer-related CTs recovered to baseline levels. However, improvement wasn't evenly distributed (all of the following changes were statistically significant):
- Screening and initial workup—Volumes were −12% and −20% from baseline, respectively (−14% and −43% in outpatient settings)
- Active cancer—Volume recovered to baseline levels in inpatient and outpatient settings and was +58% in EDs but was −10% at Mass General vs. +42% at the university-affiliated community hospital (UACH) studied
- Surveillance—Volumes rebounded across all three hospital types and in outpatient settings (total +16%)
- Outpatient settings—Volume recovered to baseline but was −8.7% at Mass General vs. +13% at the UACH
- Inpatient settings—Volume was +15% at Mass General and +81% at the UACH
- EDs—Volume was +33% overall
For future health crises, systems should plan how to preserve cancer-related CT in outpatient clinics at centers equipped to manage complex oncology cases.
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