Oct 29, 2020
In today’s episode, we hear from Dr. Debra Patt, a breast cancer specialist and the Vice President of Texas Oncology, about an alarming decline in new cancer diagnoses among senior citizens in the United States during the COVID-19 pandemic. Dr. Patt, who is also the editor-in-chief of JCO Clinical Cancer Informatics, discusses a new study that highlights the need to act to protect care now because it could take years for research to reveal the true impact of the pandemic.
Transcript
ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll. Today I'm speaking with Dr. Debra Patt, a breast cancer specialist in Austin, Texas and the vice president of Texas Oncology. Dr. Patt also serves as editor-in-chief of JCO Clinical Cancer Informatics. She is the lead investigator of a new study about an alarming decline in new cancer diagnoses among senior citizens amid the COVID-19 pandemic (DOI: 10.1200/CCI.20.00134).
Dr. Patt joins me today to warn that
this is a critical issue that needs immediate attention. Dr. Patt
has received research funding from Merk, Eisai,
Seattle Genetics, and Eli Lilly, and serves as medical director of
analytics for McKesson Specialty Health. Full disclosures relating
to all Daily News podcasts are available on our episode
pages. Dr. Patt, welcome to the ASCO Daily News
podcast.
Dr. Debra Patt:
Thank you, Geraldine, for having me.
ASCO Daily
News: So the study we're discussing today is entitled
"The
Impact of COVID-19 on Cancer Care: How the Pandemic is Delaying
Cancer Diagnosis and Treatment for American Seniors." So this
study looked at trends in diagnosis and treatment of over six
million Medicare beneficiaries. Tell us about your concerns for
this vulnerable patient population.
Dr. Debra Patt:
Yes, Geraldine. So thank you for heightening awareness of this
important issue. I think as we've all observed many changes in
medicine that pertain to the COVID-19 pandemic, one of the biggest
concerns I have is its impact on cancer care. So we looked at a
population of Medicare beneficiaries through a claims database and
identifying over 6.2 million Medicare beneficiaries to try to
understand how diagnosis and treatment was influenced by the
COVID-19 pandemic.
And we observed that screening rates
were dramatically down. Surgeries and biopsies were dramatically
down. New cancer diagnoses were dramatically down. And therapeutic
interventions were dramatically down during that time period of
March through July. This is corresponding to the time period, of
course, that the United States has been dealing with the COVID-19
pandemic. And it raises a lot of concerns.
ASCO Daily
News: Yeah, I'm looking at the numbers in this study.
And they're truly staggering. At the peak of the pandemic in April,
screening for breast, colon, prostate, and lung cancer were lower
by 85%, 75%, 74%, and 56% respectively. This may have repercussions
that are not fully understood for decades.
Dr. Debra Patt:
You're absolutely correct, Geraldine. I think what I find most
concerning is when we look at decreases in cancer screening that
we've observed in March, April, May, June, and July that have been
as high as 85% for screening mammography in April among Medicare
beneficiaries that we have not yet seen a compensation for the
delinquency or the gap that we have in screening today.
So all of those patients who, of
course, have gotten cancer and have cancer grow during that time
period remain undiagnosed. So we've not yet seen a compensatory
increase in screening to make up for the gap that exists
today.
There's a lot of concern that the
natural consequence of delays in screening without a quick uptake
to close the gap could translate into a stage migration where
patients present with higher stage disease, increasing morbidity
and increasing cancer mortality.
In fact, there was a nice study
published in Lancet Oncology in August that took
information from the UK database, the National Health Service
(DOI: 10.1016/S1470-2045(20)30388-0). And they predicted that based on the decreases
they were seeing in cancer diagnoses that cancer mortality would
increase for colorectal cancer by 15%, for breast cancer by 8% to
9%, and for lung cancer by 5% in the years to come.
ASCO Daily News: Is there anything else that really startled you from this study?
Dr. Debra Patt: I
think, Geraldine, the biggest things that concerned me were the
trends towards continued delays in cancer diagnosis. So I think
cancer treatments follow diagnosis. So if you see delays in
diagnosis, you then will see decreases in treatments. And so the
fact that they're persistent tells me that this is a problem that
will have repercussions that last for many years to
come.
Obviously, if you have a delay in a
cancer screening where cancer is diagnosed at a more advanced
stage, sometimes it conveys additional treatments and an increase
in mortality risk. But that actual cancer mortality may not come
for 5 to 10 years down the road. And so the ways in which we're
diagnosing cancer today or the decline in cancer diagnoses today
will likely continue to alter breast cancer, colon cancer, lung
cancer mortality for years to come.
ASCO Daily
News: Well, for patients and their families, it is
just gut-wrenching to know that they will be potentially dealing
with a much worse prognosis because of a delayed diagnosis
resulting from this pandemic. And this presents a very difficult
situation for oncologists as well. Have you encountered patients
who were diagnosed late?
Dr. Debra Patt:
Many. So in many different ways, what we are observing from this
data that we reported is delays in screening and diagnostics. And
that's certainly true. And I have observed that in my practice.
It's early still to make these observations.
But I have diagnosed patients with
aggressive breast cancer who delayed their screening mammogram
because of COVID-19 and then presented with a breast mass or got a
mammogram six months later and then had a cancer that was more
advanced.
The two patients I have in mind then
required chemotherapy when, had their cancer been diagnosed much
smaller, maybe they would not have required chemotherapy. It also
conveys a higher risk of cancer mortality. So those are subtle
changes.
But the big changes that we haven't
characterized in this study is actually the symptom neglect that we
see. There's a real fear particularly among Medicare
beneficiaries--and it's been reported in the Medicare beneficiary
survey--of Medicare beneficiaries seeking care from their doctors.
And as a natural consequence of that, we have observed symptom
neglect.
So as I take call on the weekends
for all of my partners here in central Texas, I observe patients
coming to the hospital after they've had 35 pounds of weight loss
or symptoms of dizziness and near syncope for many months.
Typically, patients wouldn't allow, if they have access to see a
doctor, they wouldn't allow symptoms to progress so severely before
they sought medical attention.
But the fear that's inherent in
leaving their home during COVID-19 results in a symptom neglect
that means that patients present when they may be much worse off.
And at that point in time, if you've become malnourished because of
a cancer diagnosis, it's very difficult for us to treat the cancer
effectively. So I think across the country, we're observing
patients presenting with very late stage cancers because of symptom
neglect. And that's a unique issue.
So I think that many of the findings
from this study in terms of delays in diagnosis you won't see
manifest until we are tracking cancer mortality in the next several
years. But we are seeing differences on a day-to-day basis in the
hospitals for the patients we serve.
ASCO Daily
News: So how do you think the oncology care community
should address the issue of symptom neglect? And how is the
community to manage the backlog within routine diagnostic
services?
Dr. Debra Patt:
That's a great question, Geraldine. With regards to symptom
neglect, we know from the Medicare beneficiaries survey that many
Medicare beneficiaries are not seeking health care because of fear
because they don't want to leave their homes (Medicare
Current Beneficiary Survey COVID-19 Summer 2020
Supplement). And sometimes, they're not seeking health care
because their doctor's office is closed, or they have diminished
capacity.
So I think that any way that
Medicare beneficiaries can feel more comfortable about seeing their
doctor or if they have ways that we can increase capacity for those
patients that those would be helpful ways to try to get patients in
and encourage them to not medically distance.
The screening issue is more
difficult because not only do some sites have limited capacity
today, but we actually need them to increase the capacity to close
the gap, the delta, of the deficiencies that we've had in the
previous six months. And that's more challenging.
I think that telemedicine is a
really useful service when we can use it. And we really need to get
on board and heighten awareness that patients need to get in for
their screenings. So that way, centers that do screenings, whether
they're radiologic centers or gastroenterologists that are
performing colonoscopies, can increase their capacity in a safe way
to make sure these patients can get served.
ASCO Daily
News: Well, the full range of gaps in cancer
screenings and treatment are not yet well-understood or
well-documented throughout the United States comprehensively. And
looking ahead to a further spike in COVID-19, what interventions
will be necessary moving forward?
Dr. Debra Patt:
It's a great question, and I think that cancer can't wait. I think
cancer screenings, biopsies, and surgeries must press on unless it
truly seems unsafe. You can imagine there have been scenarios in
the last year where the COVID-19 prevalence is so high, and medical
demand exceeds supply of medical professionals.
In those scenarios, I know many
governors have issued restrictive orders to try to make sure to
protect the health care delivery system. But outside of that true
emergency, I think that we need to encourage people to safely get
the care that they need--screenings, biopsies, surgeries. It's
really important.
And given the current
environment--now we're on a national spike again here in
October--we need to learn how to safely navigate and live in this
environment because it doesn't look like it's a very short-term
duration before it turns around. And so we need to make sure that
we engage with our doctors who by and large have implemented the
Centers for Disease Control and Prevention (CDC) guidelines, are
socially distancing and masking, and provide safe ways for patients
to get treatment. So I think that we need to encourage patients to
participate in screening in that way that is by and large
safe.
I think in contrast to what the
environment was like in the United States in March, now in doctor's
offices, CDC guidelines are widely implemented. By and large,
populations are masking. And people can navigate the environment
with great safety.
ASCO Daily
News: Right. Well, it's very important that you
brought these issues to light. Is there anything else that's on
your mind today that you'd like to share before we wrap up the
podcast?
Dr. Debra Patt:
Well, Geraldine, mostly I want to thank you for heightening
awareness to this issue. There's not an oncologist in the world
that doesn't believe in the words of Benjamin Franklin that, "an
ounce of prevention is worth a pound of cure." And our ability to
cure cancer is really best when we can prevent it. And that begins
with patients seeking care with their doctors and participating in
early screening.
So please encourage those around you
to make sure that they're getting those preventative services, and
then I think that the rest will follow. I think the natural
consequence of us not embracing that strategy is that cancer
morbidity and mortality will likely be elevated for years to
come.
ASCO Daily
News: Absolutely. Well, thank you so much, Dr. Patt,
for taking the time to discuss the study with us today on the ASCO
Daily News podcast.
Dr. Debra Patt:
Yes. Thank you so much for your time, Geraldine.
ASCO Daily
News: And thanks to our listeners for joining us
today. We'd love to hear from you. So please take a moment to rate
and review us wherever you get your podcasts.
Disclosures: Dr. Debra Patt
Employment: Texas Oncology, McKesson, MEDNAX (I)
Leadership: McKesson, MEDNAX (I), Texas Oncology
Stock and Other Ownership Interests: MEDNAX (I)
Speakers’ Bureau: Pfizer
Research Funding: Merck (Inst), Eisai (Inst), Seattle Genetics (Inst), Eli Lilly (Inst)
Travel, Accommodations, Expenses: McKesson
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