In a new study by researchers from the American Cancer Society (ACS) discovered deaths with cancer as the underlying or primary cause decreased in the United States during the first year of the pandemic in 2020 compared to 2019, continuing the decreasing trend from prior years. In contrast, mortality rates with cancer as a contributing cause were higher in 2020 compared to 2019, reversing the decreasing trend from prior years. The study was published as an original report in the April 11, 2023 online edition of the Journal Oncology Practice (JOP).
“Individuals living with cancer were at higher risk of COVID-19 infection and experiencing more severe symptoms due to their health conditions and treatment-related immune suppression,” said Jingxuan Zhao, MPH, senior associate scientist, health services research at the American Cancer Society and lead researcher on the study.
“The stay-at-home orders and the discontinuation of non-emergency treatment to limit hospital capacity and reduce transmission at the beginning of the pandemic may have resulted in delayed cancer screenings, diagnoses, and treatments, and possibly contributed to increased mortality,” Zhao added.
For the study, ACS scientists looked at data from the Underlying and Multiple Cause of Death database for the years 2015 through 2020, which is part of the CDC’s Wide-ranging Online Data for Epidemiological Research (WONDER) and produced by the National Center for Health Statistics. Researchers identified cancer-related deaths with invasive cancer listed as the underlying or contributing cause of death. Age-standardized cancer-related mortality rates for 2020 were compared to those for 2015-2019 and stratified by sex, race/ethnicity, urban or rural residence, and place of death.
The researchers found that the death rate (per 100,000 person-years) with cancer as the underlying cause was lower in 2020 compared with 2019 (144.1 v 146.2), continuing the past trend observed in 2015-2019.
However, by contrast, the death rate with cancer as a contributing cause was higher in 2020 than in 2019 (164.1 v162.0), reversing the continuously decreasing trend from 2015 to 2019.
American Cancer Society scientists projected 19,703 more deaths with cancer as a contributing cause in 2020 than expected based on historical trends. Mirroring pandemic peaks, the monthly death rates with cancer as a contributing cause first increased in April 2020 (RR: 1.03, 95% CI: 1.02–1.04), subsequently declined in May and June 2020, then increased again each month from July through December 2020 compared to 2019, with the highest rate ratio in December (RR: 1.07, 95% CI: 1.06–1.08).
“More research is needed to better understand the reasons for such an increase in deaths with cancer as a contributing cause,” said Zhao.
“We need to continue monitoring the long-term cancer-related mortality trends and how the COVID-19 pandemic affected cancer diagnosis and receipt of care.”
 Zhao J, Han X, Miller KD, Zheng Z, Nogueira L, Islami F, Jemal A, Yabroff KR. Association of the COVID-19 Pandemic and Changes in Patterns of Cancer-Related Mortality in the United States. JCO Oncol Pract. 2023 Apr 11:OP2200522. doi: 10.1200/OP.22.00522. Epub ahead of print. PMID: 37040580.
Featured image Photo by Önder Örtel on Unsplash. Used with permission.