Lung Cancer Detection Trends Show Shift in Pandemic Aftermath

In the conclusion to our interview with Jessica K. Paulus, ScD, senior director of real-world research, Ontada, a business of McKesson, she continues the discussion on how the COVID-19 pandemic has affected the lung cancer space. In the previous segment, she explained the pandemic’s potential impact on advanced-stage disease detection trends, and here she further explains how those findings may translate to the real world.

Transcript

How do your findings of more cases of advanced disease and fewer cases of early-stage disease may or may not reflect real-world trends?

There's been so much interest in the cancer prevention community around some of the stage shifts that we saw in and around and after the COVID-19 pandemic, and this has been observed for breast cancer, for other cancers, where screening is at the population level. At this point, lung cancer screening is targeted only for high-risk individuals. But we have seen in other diseases—like again, breast and colorectal cancer—a stage shift in the wrong direction around the COVID-19 pandemic. We know that patients were deferring or delaying or skipping screening scans because of that benefit-risk trade-off around COVID-19 infection risk. Of course, also there was repurposing of health-system resources around the pandemic. So it wasn't necessarily just patient behavior, but also reallocation of resources directed toward patients who were infected with COVID-19.

Because of all of that, there's sort of been documentation across multiple sources, real-world data sources, registry sources, observing this stage shift around 2020, 2021, 2022, and for many diseases, there is intense interest in understanding when that uptick is going to come back down, or if it's going to come back down. Because we of course hope that that's going to be course corrected back to “normal,” now that we are in a state where the risk of COVID-19 is quite different in terms of the available therapies, vaccines, etc, as well as the normalization of health care resources.

With all of that background, we ended up seeing the same shift in our data. We saw an uptick, or a small shift, toward more advanced stage for both small cell and non–small cell lung cancer at in the years 2020, 2021. In our data, that uptick also did not come back down yet. And as I mentioned earlier, because of the nature of our data, we can't really confirm that this is because of the pandemic—this is purely descriptive—but we did see that same trend in our data that has been observed for other cancers in the United States.