Trends in cancer imaging by indication, care setting, and hospital type during the COVID-19 pandemic and recovery

Background: The delivery of cancer care has been greatly affected by the COVID pandemic. We aim to investigate the effect of the pandemic on computed tomography (CT) imaging of cancer. Methods: Cancer-related CT exams were retrospectively analyzed during three periods of 2020: pre-COVID (1/5/20-3/14/20), COVID peak (3/15/20-5/2/20) and post-COVID peak (5/3/20-11/14/20). Volumes were assessed by 1) Imaging indication: cancer screening, initial workup, active cancer, surveillance;2) Care setting: outpatient, inpatient, ED;3) Hospital type: quaternary academic center (QAC), university-affiliated community hospital (UACH), sole community hospitals (SCHs). Results: During the COVID peak, a significant drop in CT volumes was observed (-42·2%, p<0·0001), with cancer screening, initial workup, active cancer and cancer surveillance experiencing declines by 81·7%, 54·8%, 30·7% and 44·7% respectively (p<0·0001, Figure 1). The emergency department (ED) was the only setting with stable cancer-related CT volumes. In the post-COVID peak period, CT volumes for cancer screening and for initial workup did not recover (-11·7%, p=0·037;-20·0%, p=0·031), with the outpatient setting particularly affected. CT volumes for active cancer recovered post-peak, but inconsistently across hospital types with the QAC experiencing a 9·4% decline (p=0·022) and the UACH a 41·5% increase (p<0·001). Outpatient CTs recovered during the post-peak period, but a shift in utilization away from the QAC (-8·7%, p=0·020) toward the UACH (+13·3%, p=0·013) was observed. Inpatient and ED-based cancer-related CTs increased post-peak (+20·0%, p=0·004 and +33·2%, p=0·009, respectively). Conclusions: COVID severely impacted cancer imaging care. CTs for cancer screening and initial workup did not recover to pre-COVID levels well into 2020, a finding that suggests higher numbers of patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed. The ED has remained a dependable healthcare delivery setting for patients with cancer throughout the pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J. Brink: Financial Interests, Institutional, Member of the Board of Directors: Accumen, Inc. All other authors have declared no conflicts of interest.