Background: Lung cancer is treated using a combination of chemotherapy, radiation therapy (RT), and surgery. The purpose of this study was to examine how the utilization of these treatment modalities at initial treatment shifted from 2019 through 2021: a period capturing healthcare before the COVID-19 pandemic, the pre-vaccination phase, and the post-vaccination phase. Methods: Claims for lung cancer treatment made between 2019 and 2021 were extracted from the database of a national healthcare organization offering commercial and Medicare Advantage health plans. Claims were excluded if they pertained to patients that were not between ages 18 and 89, or if the patient had received lung cancer treatment in the prior 12 months. For each month, the number of members enrolled in a health plan and the number of patients with diagnosis code-based evidence of lung cancer and any claims for chemotherapy, RT, or surgery were noted. Treatment utilization was measured as the number of patients receiving care per thousand health plan members. Mann Kendall tests were used to assess the monotonicity of the monthly trend in the use of the three types of treatment, as well as the use of any treatment. Tau (Τ) and significance were reported. The proportion of health plan members using each of these types of treatment in 2020 and 2021, relative to 2019, was determined on a month-by-month basis to account for seasonality and then plotted. Results: The study considered 154.5 million member-months of data over a 36-month span. Overall, there was a significant, monotonic decline in the rate at which patients received any treatment (Τ=-0.35; P<0.01), chemotherapy, (Τ=-0.57; P=<0.01), RT (Τ=-0.40; P<0.01), and surgery (Τ=-0.33; P<0.01). Relative to utilization in December 2019 (Fig. 1), 91.0% as many patients received any treatment in December 2020, and 95.5% as many patients received any treatment in December 2021. Utilization relative to December 2019 declined most sharply for surgery (77.2% in 2020; 53.9% in 2021), most moderately for RT (88.9% in 2020; 89.7% in 2021), and to an intermediate degree for chemotherapy (86.4% in 2020; 65.9% in 2021). Conclusions: These findings collectively suggest that there was a per-capita reduction in lung cancer treatment in both phases of the pandemic. While RT utilization somewhat rebounded, surgery and chemotherapy utilization continued their decline in 2021.
Month-by-month utilization in 2020 and 2021, relative to the same month in 2019.
Citation: Journal of the National Comprehensive Cancer Network 21, 3.5; 10.6004/jnccn.2022.7127
