A Comprehensive Analysis of the Impact of the COVID-19 Pandemic on Lung Cancer in Delaware.

Background: COVID-19 has greatly impacted the U.S. health system. What is not as well-understood is how this has altered specific aspects of lung cancer care. While cancer incidence and screening have been affected, it is not known whether pre-existing racial and socioeconomic disparities worsened or if treatment standards changed. The purpose of this study is to provide a comprehensive analysis of the impact of COVID-19 on lung cancer in the state of Delaware. Methods: Health care claims were analyzed from the Delaware Healthcare Claims Database for the years 2019-2020. Patients with a new lung cancer diagnosis and those who had undergone lung cancer screening were identified. Demographic and socioeconomic variables including gender, age, race, and insurance were studied. Patients were analyzed for type of treatment by CPT code. The intervention of interest in this study was the institution of restrictions at the end of March 2020. An interrupted time series analysis (ITSA) was utilized to evaluate baseline levels and overall trend changes. Results: The incidence of lung cancer diagnoses and lung cancer screenings decreased in the nine-month time period after the initiation of COVID-19 lockdowns. Demographic and socioeconomic variables including gender, race, income, and education level were not affected; however, statistical differences were seen in the most elderly subgroup. Treatment modalities including number of surgeries, chemotherapy, and radiation therapy did not change significantly. Conclusions: COVID-19 has had a significant impact on lung cancer care within the state of Delaware. Lung cancer incidence, screenings, and elderly patients were affected the most.