Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic
Meghan J. Walker, Jonathan Wang, Joshua Mazuryk, Siew-Mei Skinner, Olivia Meggetto, Eta E. Ashu, Steven Habbous, Narges Nazeri Rad, Gabriela Espino-Hernández, Ryan Wood, Munaza Chaudhry, Saba Vahid, Julia Gao, Daniela Gallo-Hershberg, Eric Gutierrez, Claudia Zanchetta, Deanna L. Langer, Victoria Zwicker, Michelle Rey, Martin C. Tammemägi, Jill Tinmouth, Rachel Kupets, Anna M. Chiarelli, Simron Singh, Padraig Warde, Leta Forbes, Julian Dobranowski, Jonathan C. Irish, Linda Rabeneck, Cancer Care Ontario COVID-19 Impact Working Group, Chamila Adhihetty, Jaclyn Beca, Diane Burns, Catherine Chan, Kelvin Chan, Lauren Chun, Melissa Coulson, Gail Darling, Prithwish De, Steven Dong, Catherine Dubé, María Eberg, Samantha Fienberg, Colleen Fox, Sophie Foxcroft, Ron Fung, Scott Gavura, Natasha Gray, Sherrie Hertz, Brian Ho, Claire Holloway, Amber Hunter, Nathaniel Jembere, Tina Karapetyan, Shivali Kaushal, Mary Jane King, Ordeena Linton, Aïsha Lofters, Andrea Mackesy, Faisal Majeed, Jessica M. Mann, Pamela MacCrostie, Garth Matheson, Bronwen R. McCurdy, Elaine Meertens, Reeza Menalo, Lisa Milgram, Nicole Moleschi, Elena Mow, Kate Murphy, Rohini Naipaul, Karen Nguyen, Diane O'Grady, Aaron Pollett, Elizabeth Quilliam, Dimpho Radebe, Jocelyn Sacco, Nancy Shukla, Vicky Simanovski, Steve Scott, Xiaochen Tai, Cristina Tassone, Arany Theivendram, Rebecca Truscott, Christa Wang, Audrey Wong, Lyndee Yeung, Marta Yurcan
Abstract
Importance: The COVID-19 pandemic has impacted cancer systems worldwide. Quantifying the changes is critical to informing the delivery of care while the pandemic continues, as well as for system recovery and future pandemic planning. Objective: To quantify change in the delivery of cancer services across the continuum of care during the COVID-19 pandemic. Design, Setting, and Participants: This population-based cohort study assessed cancer screening, imaging, diagnostic, treatment, and psychosocial oncological care services delivered in pediatric and adult populations in Ontario, Canada (population 14.7 million), from April 1, 2019, to March 1, 2021. Data were analyzed from May 1 to July 31, 2021. Exposures: COVID-19 pandemic. Main Outcomes and Measures: Cancer service volumes from the first year of the COVID-19 pandemic, defined as April 1, 2020, to March 31, 2021, were compared with volumes during a prepandemic period of April 1, 2019, to March 31, 2020. Results: During the first year of the pandemic, there were a total of 4 476 693 cancer care services, compared with 5 644 105 services in the year prior, a difference of 20.7% fewer services of cancer care, representing a potential backlog of 1 167 412 cancer services. While there were less pronounced changes in systemic treatments, emergency and urgent imaging examinations (eg, 1.9% more parenteral systemic treatments) and surgical procedures (eg, 65% more urgent surgical procedures), major reductions were observed for most services beginning in March 2020. Compared with the year prior, during the first pandemic year, cancer screenings were reduced by 42.4% (-1 016 181 screening tests), cancer treatment surgical procedures by 14.1% (-8020 procedures), and radiation treatment visits by 21.0% (-141 629 visits). Biopsies to confirm cancer decreased by up to 41.2% and surgical cancer resections by up to 27.8% during the first pandemic wave. New consultation volumes also decreased, such as for systemic treatment (-8.2%) and radiation treatment (-9.3%). The use of virtual cancer care increased for systemic treatment and radiation treatment and psychosocial oncological care visits, increasing from 0% to 20% of total new or follow-up visits prior to the pandemic up to 78% of total visits in the first pandemic year. Conclusions and Relevance: In this population-based cohort study in Ontario, Canada, large reductions in cancer service volumes were observed. While most services recovered to prepandemic levels at the end of the first pandemic year, a substantial care deficit likely accrued. The anticipated downstream morbidity and mortality associated with this deficit underscore the urgent need to address the backlog and recover cancer care and warrant further study.