The number of patients undergoing lung cancer screening at a diverse inner-city New York medical center decreased by nearly 30% during the COVID-19 pandemic compared to pre-pandemic levels, according to a poster presented at RSNA 2021.
Stahl
Maximillian C. Stahl, a medical student at Albert Einstein College of Medicine in New York City, discussed his retrospective chart review of patients enrolled in the lung cancer screening program at Montefiore Medical Center between March of 2019 and March of 2021. Mr. Stahl and a team of researchers compared enrollment during two distinct time periods: pre-pandemic from March 28, 2019 to March 21, 2020, and during the pandemic from March 22, 2020 to March 17, 2021.
During the pandemic period, a total of 857 exams were performed, a 29.6% decrease compared to the pre-pandemic period of 1,218 exams. The mean age of all screening participants was 66.9; female enrollees comprised 51.9% of the study group.
Of the screening enrollees, 20.7%/20.3% were white and 42%/36.3% were Hispanic/Latino in the pre-pandemic and pandemic time periods, respectively. Mr. Stahl said the diversity of this patient population at the Montefiore Medical Center distinguished his study from other research on the effect of the COVID-19 pandemic on lung cancer screening programs, which have been conducted on predominantly white patient populations.
"Our patient population in the Bronx is not only diverse and underserved, it had the highest number of hospitalizations and highest death rates within the five NYC boroughs at the peak of the pandemic," Stahl said. "We serve a portion of the U.S. that has been disproportionately affected by COVID."
Volumes Plummet as Pandemic Takes Hold
The center's lung screening volume decreased to its lowest point during the initial New York state lockdown in April and May of 2020, with 14 and 10 exams performed, respectively. Exam volume rebounded in September 2020 to pre-pandemic levels (131 exams), before declining again to 43 per month during the second COVID-19 wave from December 2020 to March 2021. There was no significant difference in Lung-RADS assessment categories scores between the two time periods.
The percentage of exams that were performed on newly enrolled patients during the pandemic also significantly decreased compared to the pre-pandemic period, from 32.7% to 13.8%.
"For a lung cancer screening program to work efficiently, you need to see patients as early as possible so that any lung nodules can be detected when they're most treatable," Stahl said.
The U.S. Preventative Services Task Force guidelines suggest annual lung cancer screening with CT imaging for adults between the ages of 50 and 80 with a 20-year pack history who currently smoke or who have quit in the past 15 years.
Stahl said during the summer of 2020, many of the country's lung cancer screening programs returned to pre-pandemic enrollment numbers.
"Our program didn't adjust as well as others," he said "We weren't able to maintain our pre-pandemic enrollments during the second wave of the pandemic."
He said that as the nation continues to adapt to the pandemic, ongoing efforts are needed to overcome its impact on underserved communities including improving patient and provider outreach and using information technology to better manage patient data.
View the digital poster, "Bend But Don't Break: Experience Of A Diverse New York City Lung Cancer Screening Program During The COVID-19 Pandemic," (CH03-C1) in the Learning Center or online at Meeting.RSNA.org
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