Cancer in the time of COVID: Trends in presentation, staging, and demographic disparities in breast, uterus, and gynecologic cancers at an NCORP site.
Authors: Myers Ellen , Davis Rivera Lauren , Chatterjee-Paer Sudeshna , Zhi Lianteng , Taylor Denise , Hall-McBride Bob , Hoffman Matthew , Sweeney Hannah 
Published: June 2023

e18809

Background: COVID-19 shutdowns decreased access to preventive care with disparate impacts on minority patients. Racial disparities in cancer diagnosis, treatment, and survival have been studied and seen in the US. Methods: All new pathologically confirmed breast, uterus, ovary, cervix, vulvar, and vaginal cancer diagnoses at an NCORP site from 01/01/2018 to 12/31/2021 were examined for trends in stage of presentation and demographics. COVID-19 shutdown was defined as 3/15/2020 to end of study period. Categorical analysis of stage by tumor type was performed using chi square tests. Demographics were analysed using Analysis of Variance tests. Results: 2173 cases were included: 1267 cases pre-shutdown, 906 post. 1583 patients identified as White, 442 as Black, 62 as Asian, 47 as Hispanic, and 39 as Other. Breast (N = 1285) and uterine cancers (N = 396) were analyzed in greater depth due to larger numbers of cases. No significant shifts were seen in the racial breakdown of new cancer diagnoses across all examined types. No significant shifts were seen in the stage at time of diagnosis. There was a decrease in new diagnoses per day post COVID with 1.58 diagnoses per day pre-shutdowns compared to 1.38 post. Breast cancer data was notable for significant differences in age of diagnoses across racial and ethnic groups: from 54 in Hispanic patients to 63 in White Patients. No significant shifts in age of diagnosis were seen. No significant difference of stage of presentation existed at any stage of diagnosis. Number of cases per day for all stages decreased post shutdowns. Largest differences were seen in stage 1A (0.62 pre, 0.43 post; -31%) and stage 1B (0.11 pre, 0.06 post; -43%). Stage 0 cases demonstrated a smaller decrease post COVID in rate of cases per day (0.19 pre, 0.16 post; -17%). Later stages beyond 1 were analyzed in aggregate due to low numbers of cases and demonstrated a decrease in presentations per day (0.09 pre, 0.07 post; -24%). Uterus cancer showed no significant difference in stage post shutdown. Diagnoses per day did not change post shutdown. Decreases in early presentations (stage 1 and 2) and increases in late presentations (stage 3 and 4) were seen, but findings were not significant and few cases were available for analysis. No shift in percentages of new diagnoses in racial and ethnic minorities were seen. Conclusions: COVID-19 shutdowns did not significantly alter stage of presentation or demographics of patients presenting with new cancer diagnoses at this NCORP site. Underlying disparities in age of presentation by racial groups were seen. Decreased numbers of new cancer diagnoses per day were seen post-shutdowns while incidence of cancer in the US is increasing overall, suggesting some patients with cancer in our community went undiagnosed and may present later or at a later stage, though future longitudinal research is needed.