Background
COVID-19’s pandemic spread in the US in early 2020 led to a drastic change in health care delivery. In April 2020 consensus statement on LC screening advised deferring enrollment in LC screening and modified the evaluation of nodules. This single institution has had an active LC screening program before COVID, which enrolled more than 300 patients per month before COVID and completed more than 11,000 screens over the last six years. Kentucky is the state with the highest LC mortality rate in the US and one of the highest smoking rates in the country. Government directed social distancing was put in place 3/14/2020.
Methods
LC Screening Registry data 2015-2020 for St Elizabeth Healthcare (SEH) was accessed. The lung cancer screening volumes listed until May 2020 were recorded and graphically illustrated using polynomial trendlines and well as monthly point by point lines. John Hopkin’s COVID Status Report on Kentucky’s and SEH surrounding counties confirmed cases, fatality rate and number of tested patients.
Results
By June 2020, Kentucky (pop 4.6m) had 13.630 confirmed COVID cases, 524 deaths and a 3.84% fatality rate with 317,161 tests performed. SEH’s surrounding counties, (pop 370k) had 386 cases per 100k population and a 4.5 % county fatality rate with 71 deaths. The county with the highest rate in the county at the time was Cook county, IL, (pop 5,2m) with 1,711 cases per 100k population and 4,500 deaths due to COVID. 379 LC screens were performed at SEH in February 2020. 212 in March and 13 LC screens in April, 114 in May. The lung cancer rate in the screened population has been 1.81% over the course of six years.
Conclusion
The consensus statement on LC screening during COVID advised a delay in LC screening, work up and treatment, even for high probability nodules and stage 1 lung cancers. A delay of LC screens in this community setting by 6 months would delay the diagnosis and treatment of 36 lung cancer cases. The course of the COVID pandemic is presently uncertain. Considering the fact that COVID will affect health care for the foreseeable future, it would be helpful to modify the recommendations based on the area’s prevalence of COVID and prevalence of lung cancer.