COVID-19 pandemic associated with reductions in delivery of cancer care services in Ontario, Canada

1. This population-based cohort study demonstrated that there was a 20.7% reduction in cancer care services in Ontario, Canada during the first pandemic year.

2. Major reductions were observed in cancer screening tests, biopsies, surgical treatments, and new consultations for systemic and radiation treatment among patients living with cancer.

Evidence Rating Level: 2 (Good)

Study Rundown: In an effort to mitigate the transmission of COVID-19 and preserve the capacity of the healthcare system, the Ontario provincial government shut down non-emergent health services include cancer screening, diagnostic procedures and some treatment courses. This population-based cohort study aimed to quantify the change in delivery of cancer services over the course of the COVID-19 pandemic among a pediatric and adult population of 14.7 million, in Ontario, Canada. The primary exposure was the COVID-19 pandemic, and the main outcome was cancer service volumes quantified during the first year of the pandemic (defined as April 1, 2020 to March 31, 2021), in comparison to the pre-pandemic period (April 1, 2019 to March 31 2020). A 20.7% reduction in cancer care services was observed within the first year of the COVID-19 pandemic, with the number of available services declining from 5,644,105 to 4,476,693, suggesting a backlog of 1,167,412 cancer services between April 2019 to March 2020. Cancer screening tests were reduced by 42.4% accounting for 87.0% of the total backlog. Additionally, cancer care services including diagnostic or surveillance colonoscopy, colposcopy, cancer treatment surgical procedures and radiation treatments further accounted for high-volume changes. A major strength of this study is its broad coverage of the cancer care continuum and its use of a population-based design. A limitation however, is that the design could not account for non-pandemic-related events that occurred during the same period.

Click to read the study in JAMA Network Open

Click to read an accompanying editorial in JAMA Network Open

Relevant Reading: The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand – a country pursuing COVID-19 elimination

In-Depth [retrospective cohort]: This population-based cohort study aimed to quantify any change in the delivery of cancer care services during the COVID-19 pandemic in Ontario, Canada. Prior to the COVID-19 pandemic there were a total of 5 644 105 cancer care services, which declined to 4 476 693 between April 2020 to March 2021, a difference of 20.7% and a backlog of 1 167 412 fewer services. Cancer care services including diagnostic or surveillance colonoscopy (difference -62 775 colonoscopies [-18.8%]), colposcopy (difference: -21 013 colonoscopies [-20.6%]), cancer treatment surgical procedures (-8020 procedures [-14.1%]), and radiation treatments (-141 629 treatments [-21.0%]) further accounted for high-volume changes. The service volume of breast MRI’s notably increased between pre-COVID-19 (11 664) and the COVID-19 pandemic (11 812) with a backlog volume of +148 and cumulative of +1.3.

Image: PD

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