The impact of the coronavirus disease 2019 (COVID-19) outbreak on cancer practice in Japan: using an administrative database

  1. Hisashi Itoshima
  2. Yuka Asami
  3. Jung-ho Shin
  4. Daisuke Takada
  5. Tetsuji Morishita
  6. Seiko Bun
  7. Takuya Okuno
  8. Susumu Kunisawa
  9. Yuichi Imanaka

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Abstract

Background: Recent researches reported the impact of the coronavirus disease 2019 (COVID - 19) pandemic on the clinical practice of specific type cancers. The aim of this study was to reveal the impact of the COVID-19 outbreak on the clinical practice of various cancers. Methods: We included hospitalized patients aged 18 years or older diagnosed between July 2018 and June 2020 with one of the top 12 most common cancers in Japan (colon/rectum, lung, gastric, breast, bladder & urinary tract, pancreas, non-Hodgkin lymphoma, liver, prostate, esophagus, uterus, and gallbladder & biliary tract) using Diagnostic Procedure Combination data, an administrative database in Japan. The intervention was defined April 2020 based on a declaration of emergency from Japanese government. The change volume of number of monthly admissions with each cancer was tested by interrupted time series (ITS) analysis, and monthly cases with radical surgery or chemotherapy for each cancer were descripted. Results: 403,344 cases were included during the study period. The most common cancer was colon/rectum (20.5%), followed by lung (17.5%). In almost cancer cases, the number of admissions decreased in May 2020. In particular, colorectal, lung, gastric, breast, uterine, or esophageal cancer cases decreased by over 10%. The number of admissions with surgery or chemotherapy decreased in colorectal, lung, gastric, breast, uterine, or esophageal cancer. ITS analysis indicated that cases with gastric or esophageal cancer were affected more than other type of cancer. Conclusions: The COVID-19 outbreak has a negative impact on the number of admission cases with cancer; the magnitude of impact varied by cancer diagnosis.

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  1. Version published to 10.1101/2020.11.18.20233700v2 on medRxiv
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    SciScore for 10.1101/2020.11.18.20233700: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical considerations: The present study was approved by the ethics committee of Kyoto University (approval number: R0135), and we did not require informed consent because of the use of anonymized data, in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects, as stipulated by the Japanese Government.
    Consent: Ethical considerations: The present study was approved by the ethics committee of Kyoto University (approval number: R0135), and we did not require informed consent because of the use of anonymized data, in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects, as stipulated by the Japanese Government.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study had several limitations. We evaluated the impact of COVID-19 on cancer care for inpatients, but not for outpatient. Events related to outpatient cancer treatment include postponing outpatient testing if they were suspected of having cancer or postponing chemotherapy in outpatients. Because chemotherapy is often administered as an outpatient procedure, it is unclear how outpatients with cancer were affected. It is also unclear how a decrease in the number of hospitalized patients is associated with cancer outcomes. In fact, the decline in the number of admission cases treated with surgery or chemotherapy was small except for some types of cancer patients, so it might have little impact on long-term prognosis. The long-term prognosis should be carefully monitored. In addition, due to the characteristics of DPC data, the number of patients who were admitted in June decreased significantly in both 2019 and 2020. Many hospitalized patients in June may still have been admitted; therefore, no DPC data are not generated without discharge, making it difficult to assess the impact of the COVID-19 pandemic in June 2020. In conclusion, our study indicated the COVID-19 outbreak might cause a decrease in the number of admission cases with cancer, and cases that received treatments such as surgery or chemotherapy were not largely affected except for some types of cancer.

    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.
    • Thank you for including a protocol registration statement.

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  3. Version published to 10.1101/2020.11.18.20233700v1 on medRxiv