New study shows more deaths with cancer as contributing cause during first year of pandemic

In a new study, American Cancer Society (ACS) researchers have discovered that 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 today in 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, 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 reduced transmission at the beginning of the pandemic may have resulted in delayed cancer screenings, diagnoses, and treatments, and possibly contributed to increased mortality."

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.

ACS 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."

Other ACS authors participating in this study include Dr. Xuesong Han, Dr. Zhiyuan Zheng, Dr. Leticia Nogueira, Dr. Farhad Islami, Dr. Ahmedin Jemal, and Dr. Robin Yabroff.