COVID-19 pandemic increased the number of cancer-related mortality in the U.S., study shows

According to a new study led by researchers at the American Cancer Society (ACS), the COVID-19 pandemic increased the number of cancer-related deaths by 3.2% in the United States from 2019- 2020. Compared to 2019, the monthly cancer-related mortality rate was higher in April 2020, when healthcare capacity was most challenged by the pandemic. Higher mortality rates were again observed each month from July to December 2020 compared to 2019. The findings will be presented at this year's annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, June 3-7.

In the study, researchers led by Jingxuan Zhao, senior associate scientist, health services research at the American Cancer Society, used the U.S. 2019-2020 Multiple Cause of Death database from the Centers for Disease Control and Prevention WONDER to identify cancer-related deaths, defined as decedents with invasive cancer as a contributing cause of death. They compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020 (pandemic) versus January-December 2019 (pre-pandemic) overall and stratified by rurality and place of death. Scientists calculated the 2020 excess death by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rate from 2015 to 2019.

The results showed the number of cancer-related deaths was 686,054 in 2020, up from 664,888 in 2019, with an annual increase of 3.2%. Compared to the number of projected deaths for 2020 (666,286), the number of cancer-related excess deaths was 19,768 in 2020. The annual age-standardized cancer-related mortality rate continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020. The cancer-related monthly mortality rate was higher in April 2020 when healthcare facilities were most challenged by COVID-19, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019. In large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020, coinciding with the time-spatial pattern of COVID-19 incidence in the country. Compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in decedent's homes.

Study authors stress ongoing evaluation of the spatial-temporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.