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COVID-19 and Its Impact on Casefinding, Caseloads, Diagnosis, Treatment and Follow Up
Cancer impact blog

Since the beginning of the COVID-19 pandemic, cancer patients and physicians have been forced to make difficult decisions regarding cancer treatments. Some cancer patients have had treatment delayed or treatment plans altered because of the pandemic, as patients with cancer are among those at high risk of infection with COVID-19. For cancer registrars, they are beginning to see the impact is having on cancer patients and how they are treated. It’s critical to understand how the pandemic will affect casefinding, caseloads, diagnosis, treatment and follow up.

Because many of us have been confined to our homes because of the pandemic, there has been a decrease in cancer diagnosis as well as cancer treatments -- which means decreases in caseloads. There also will be fewer pathology reports and fewer cases in suspense in the coming months. Registrars are already starting to see delays in workups and treatments because of the pandemic restrictions.

Registrars are likely to see a decrease in colonoscopies, mammograms, PSA testing and lung CT scanning. Additionally, cancer programs may be canceling their screening and prevention activities. Some of our staff have already seen documentation about delays in treatment or treatment modifications when they are in the EMR abstracting cases.

At the onset of this pandemic, hospitals needed to conserve critical resources, such as hospital and ICU beds, ventilators, as well as personal protective equipment critical for protecting patients, care providers and staff. It was generally advised that hospitals discontinue elective surgeries, particularly with patients that have a high likelihood of the need to utilize the ICU postoperatively or patients who may require respiratory equipment. This resulted in canceled or postponed surgical procedures.

There have been non-surgical changes in care since the beginning of the pandemic. Hospitals reduced patient time to avoid infection in immunocompromised patients, managed staffing shortages and aided patients with transportation issues. Cancer patients opted out of visiting the hospital in fear of being exposed, and some had to stay at home or self-quarantine due to a spouse or family member testing positive for COVID-19. All of these factors have contributed to changes in the delivery of systemic care and physicians are modifying treatment plans. This can mean that IV chemotherapy may be changed to oral chemotherapy or immunotherapy. Hormone therapy may be started before surgery.

We are also seeing major delays in radiation therapy. What is the impact on data collection? Registrars may see an increase in the incidence of neoadjuvant therapy or an increase in active surveillance or patients with no treatment, which may affect the assignment of Class of Case. CTRs will need to utilize “Reason No” codes for “Reason No Surgery” and “Reason No Radiation.” Although the “Reason No Chemotherapy” and “Reason No Hormone Therapy” fields are no longer required, we recommend using those, particularly during this pandemic. 

What is the impact on data collection? Registrars may see an increase in the incidence of neoadjuvant therapy or an increase in active surveillance or patients with no treatment, which may affect the assignment of Class of Case. CTRs will need to utilize “Reason No” codes for “Reason No Surgery” and “Reason No Radiation.” Although the “Reason No Chemotherapy” and “Reason No Hormone Therapy” fields are no longer required, we always recommend completing those fields, particularly during this pandemic.

The cancer registry should lead the way in capturing data on these treatment delays, treatment modifications and COVID-19 positivity and impacts on cancer care. Ask your cancer registrar to create additional fields to capture this information. At a minimum, everyone should collect COVID-19 positivity (yes or no) and Treatment Delayed due to COVID -19 (yes or no). This information will help inform hospitals and physicians on the true impact of COVID-19 on cancer.

To find out more about how the pandemic may affect cancer program activities as well as updates from The Annals of Internal Medicine, the American College of Surgeons and the Commission on Cancer, please visit our resources page to view our “2020 Pandemic and the Cancer Registry” webinar.

This article was featured in the Association of Cancer Executives' July 2020 newsletter. 

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About the Author

Karen Schmidt, CTR

Karen Schmidt

17+ Years of Cancer Registry Experience

ASK ME ABOUTMaximizing Registry Data for Administrative Planning, Migration Analysis & Financial Impact, Streamlining Registry Processes, Cancer Program Standards



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