Impact of the COVID-19 Pandemic on Treatment Patterns for Patients With Metastatic Solid Cancer in the United States

  1. Ravi B Parikh
  2. Samuel U Takvorian
  3. Daniel Vader
  4. E Paul Wileyto
  5. Amy S Clark
  6. Daniel J Lee
  7. Gaurav Goyal
  8. Gabrielle B Rocque
  9. Efrat Dotan
  10. Daniel M Geynisman
  11. Pooja Phull
  12. Philippe E Spiess
  13. Roger Y Kim
  14. Amy J Davidoff
  15. Cary P Gross
  16. Natalia Neparidze
  17. Rebecca A Miksad
  18. Gregory S Calip
  19. Caleb M Hearn
  20. Will Ferrell
  21. Lawrence N Shulman
  22. Ronac Mamtani
  23. Rebecca A Hubbard
  24. the PRACTICE Investigators

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Abstract

Background

The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic’s impact on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metastatic solid cancer.

Methods

We used an electronic health record–derived longitudinal database curated via technology-enabled abstraction to identify 14 136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at approximately 280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on TTI, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy.

Results

The adjusted probability of treatment within 30 days of diagnosis was similar across periods (January-March 2019 = 41.7%, 95% confidence interval [CI] = 32.2% to 51.1%; April-July 2019 = 42.6%, 95% CI = 32.4% to 52.7%; January-March 2020 = 44.5%, 95% CI = 30.4% to 58.6%; April-July 2020 = 46.8%, 95% CI= 34.6% to 59.0%; adjusted percentage-point difference-in-differences = 1.4%, 95% CI = −2.7% to 5.5%). Among 5962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences = 1.6%, 95% CI = −2.6% to 5.8%). There was no meaningful effect modification by cancer type, race, or age.

Conclusions

Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not affect TTI or treatment selection for patients with metastatic solid cancers.

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  1. Version published to 10.1093/jnci/djab225
  2. ScreenIT

    SciScore for 10.1101/2021.09.22.21263964: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines and was exempted by the University of Pennsylvania and WCG Institutional Review Boards prior to study conduct owing to use of de-identified data only.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    Covariates included age, gender, race (non-Hispanic White, non-Hispanic Black, Hispanic, or other), insurance type (commercial, government, or other), Eastern Cooperative Oncology Group (ECOG) performance status (<2 or ≥2), documented opioid medication order (yes or no), calendar day of metastatic cancer diagnosis, and cancer type.
    non-Hispanic White
    suggested: None

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our study has several limitations. First, it is a retrospective study of a sample of predominantly community-based US oncology practices, and therefore our findings may not be reflective of all oncology practice. However, this database has been shown to be broadly representative of US oncology practices and patients.41 Second, outpatient EHR data may incompletely capture important variables that contribute to treatment patterns, such as patient preference or comorbidities, thus raising the possibility of unmeasured confounding. However, our quasi-experimental approach should account for these unmeasured confounders, assuming such confounders were consistent across time periods. Third, while we used the most up-to-date data available, there may be COVID-related delays in data capture affecting completeness of data from more recent time-periods. In particular, the pandemic could impact capture of metastatic cancer diagnoses. While this remains a hypothetical concern, future analyses should address this possibility. Fourth, our cohort was limited by a relatively small proportion of racial minorities and those with noncommercial insurance. This may have resulted in limited power for analyses of race- or age-based interactions, though notably there was some, non-statistically significant, evidence of delayed treatment among African-American patients. Given the disproportionate impact of the pandemic on care for minority groups, future analyses with larger, more divers...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.09.22.21263964v1 on medRxiv