Clinical PET/CT utilization during the COVID-19 pandemic: initial experience at Yale University

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a positive-sense RNA virus causing coronavirus disease 2019 (COVID-19), an ongoing pandemic claiming millions of lives [1–3]. Rapidly evolving SARS-Cov-2 outbreak continues with recent spikes in cases in some countries, while few have significantly curbed the numbers of new cases thanks to the recent deployment of vaccines [3]. Connecticut is a relatively small-sized northeastern state (approximate population 3.5 million) that is ranked #3 in healthcare access among the US states, according to US News data. The geographical proximity of the state of Connecticut to New York, an epicenter of the initial outbreak in the USA, resulted in the immediate spread of the virus in the Connecticut area as well. Governors of New York, New Jersey and Connecticut followed a similar course of action, and the timeline of the pandemic followed a similar path in this region. The first case in our hospital system was seen on 8 March 2020. Decreased numbers of screening studies and elective surgeries, as well as on in-person appointments took in place in parallel with state-wide administrative policy implementations. COVID-19 has less favorable clinical outcomes in patients with preexisting health conditions including cancer [4]. Unprecedented strain in healthcare systems and rapid development of the outbreak led to readjustment of cancer treatment, deferral of procedures and alteration of surveillance algorithms [5]. The dual danger of COVID-19 and cancer have forced practitioners to make decisions based on experience and risk/benefit analysis, particularly at the early stage of the pandemic, due mainly to the scarcity of clinical and epidemiologic data on COVID-19. Identification of factors that are potentially associated with the decline in molecular cancer imaging, will help better understand the dynamics of cancer imaging at the time of respiratory outbreaks. Providing real-world data during a pandemic may play a role in understanding potential vulnerabilities in similar future outbreaks or the future waves of COVID-19 outbreak that may ensue. This may also assist oncology practitioners to manage imaging studies of their patient population in an evidence-based approach. A decline in the volume of radiology studies as well as in nationwide new cancer diagnoses in 2020 as compared to prior years has been shown [6,7]. Two Italian studies recently demonstrated a potential increase in interstitial lung findings in cancer patients during the COVID-19 pandemic [8,9]. The impact of the COVID-19 pandemic on cancer imaging based on factors such as cancer types, patient demographics and imaging findings is not well-demonstrated in the literature, particularly with respect to epidemiologic dynamics. In this study, we aimed to analyze the impact of the ongoing pandemic on molecular imaging of cancer patients in a comprehensive cancer hospital by in-depth analysis of all PET/CT studies from 1 January 2020 through 15 June 2020. The aims of this study were: (1) to determine temporal changes in PET/CT utilization during the COVID-19 pandemic; (2) to correlate PET/CT utilization and state-wide number of COVID-19 cases within the same period in the light of restrictive policy implementations; (3) to examine the impact of demographic and oncological factors on PET/CT utilization and (4) to examine the number of cases discussed in multidisciplinary tumor boards during the same period.