App Calculates Risk of Delaying Cancer Care During Pandemic

The University of Michigan’s OncCOVID app draws on global cancer and coronavirus data to create an individualized mortality risk assessment for receiving immediate versus delayed cancer treatment.

12:05 PM

Author | Ian Demsky

COVID app 2

Editor's note: Information on the COVID-19 crisis is constantly changing. For the latest numbers and updates, keep checking the CDC's website. For the most up-to-date information from Michigan Medicine, visit the hospital's Coronavirus (COVID-19) webpage

Interested in a COVID-19 clinical trial? Health research is critical to ending the COVID-19 pandemic. Our researchers are hard at work to find vaccines and other ways to potentially prevent and treat the disease and need your help. Sign up to be considered for a clinical trial at Michigan Medicine.

As the COVID-19 pandemic has overwhelmed healthcare systems across the country, doctors have postponed surgery and other treatments for thousands of patients with cancer. These delays may last for months, especially for those with early stage and less aggressive disease.

Unfortunately, there hasn't been a good way for doctors to compare the long term risk to a patient from a months-long postponement of care to the additional risk posed by potential COVID-19 infection if they undergo surgery, chemotherapy and/or radiation.

So, a team of data scientists and cancer doctors from the University of Michigan Rogel Cancer Center and the U-M School of Public Health developed a free, web based application to do just that.

The OncCOVID app draws on large, national cancer data sets to help assess the risk from of immediate treatment versus delayed treatment, depending on a patient's individual characteristics, as well as on COVID's impact on their local community.

"For many types of cancer, the data show delays in treatment lead to worse outcomes for patients," says the project's lead researcher, Holly Hartman, a doctoral student in biostatistics at U-M. "But each time a cancer patient goes to the hospital to receive care, they're also putting themselves at higher risk of contracting COVID-19. So, it's essential to balance the need for treatment for this very serious disease and the extra risk that COVID-19 poses for cancer patients, whose immune systems are often compromised."

The researchers envision OncCOVID being used by doctors to help identify patients whose risk from COVID is outweighed by the benefits of immediate treatment.

MORE FROM THE LAB: Subscribe to our weekly newsletter

"We also see the app providing additional reassurance to oncologists and their patients when the data show that delaying treatment will likely have little or no impact on a patient's long-term outcome," Hartman adds.

Meanwhile, OncCOVID could also be used by health care systems that are ramping services back up and need to prioritize a backlog of patients whose treatment was put on hold due to the pandemic, adds Daniel Spratt, M.D., an associate professor of radiation oncology at Michigan Medicine and one of the senior researchers on the project.

"Hospitals have basically been using a three-tiered system during COVID: treat, delay a little, or delay a lot," Spratt says. "Unfortunately, this tiered system is an extremely blunt instrument. Our goal was to create a resource that could be tailored both to the individual patient and to their local community."

The app allows doctors to enter more than 45 characteristics about a patient — including their age, location, cancer type and stage, treatment plan, underlying medical conditions, and the proposed length of a delay in care. It then calculates the patient's likely five-year survival following immediate treatment and delayed treatment.

Under the hood, the app draws on millions of records contained in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry and the National Cancer Database, combined with county-level COVID infection data from Johns Hopkins University.

In some cases, the personalized risk assessments run counter to the generic, three-tiered approach.

It's essential to balance the need for treatment for this very serious disease and the extra risk that COVID-19 poses for cancer patients, whose immune systems are often compromised.
Holly Hartman

For example, Spratt says, the team's model shows that an otherwise healthy 45-year-old woman from Ann Arbor, Mich. with stage 1 breast cancer actually has a slightly higher risk of dying over the next five years if treatment is delayed by more than three months than if she's treated immediately.

"Under the three-tiered model, care for this patient wouldn't be considered life-threatening and it's likely her care may be delayed for months under most of the published tier-based systems," he notes.

Conversely, under the team's data model, a 70-year-old woman from New York City — where COVID infections have been high — with stage 1 breast cancer and several underlying health conditions would be put at significantly more risk by undergoing immediate treatment than the risk posed by a three-month delay.

For the data savvy, advanced features allow all of the app's underlying statistical assumptions to be adjusted — such as the baseline mortality risk from COVID and the disease's infection rate.

Like Podcasts? Add the Michigan Medicine News Break to your Alexa-enabled device or subscribe for updates on iTunesGoogle Play and Stitcher.

In the future, the researchers plan to use the same data model to start looking at the effects that treatment delays due to the coronavirus pandemic may have on cancer mortality nationally, Hartman adds.

The OncCOVID app is not intended to provide medical advice to patients, the researchers caution. A number of factors may figure into a care provider's recommendation to delay or proceed with cancer treatment, including their local hospital's capacity to safely treat cancer patients during the pandemic.

Matthew Schipper, Ph.D., associate professor of radiation oncology and biostatistics at U-M, was also a co-creator of the app. Other collaborators on the project include: Nicholas G Zaorsky, Xi Wang, Ming Wang, and Vonn Walter of Pennsylvania State University; and Yilun Sun, Emily Morris, Elizabeth Chase, Theresa Devasia, Pin Li, Kelley Kidwell, Robert Dess and William Jackson of U-M.

The work was supported, in part, by grants from the National Institutes of Health.

Watch an in-depth discussion of the OncCOVID app by radiation oncologist Daniel Spratt, M.D., a senior researcher on the project.

More Articles About: Health Tech Covid-19 Health Care Delivery, Policy and Economics Cancer Research infectious disease
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories sketched out bacteria in a dish yellow and blue colors of U-M
Health Lab
This gross mixture has big benefits for the study of bacteria
Michigan Medicine researchers have found that growing bacteria on agar mixed with organs is an efficient and effective way to study infectious pathogens.
supar molecule teal blue yellow red
Health Lab
Immune protein suPAR links viral infection as possible cause of kidney disease
Through a series of experiments in non-human primates, mice and humans, a multi-institutional team led by researchers from Michigan Medicine and Rush University found that the immune protein soluble urokinase plasminogen activator receptor, or suPAR, is an important link between viral infections and proteinuria; the elevation of protein in the urine is known to cause glomerulopathy, a common form of kidney disease.
person holding walker with nurse next to them closer up on hands lower body
Health Lab
Long COVID happens in nursing homes, too
Post-acute sequelae of Sars-COV2 (PASC, long COVID) caused a decrease in independence and cognitive ability after coronavirus infection in nursing home residents
expert at stand hearing in suit
Health Lab
Keep telehealth alive and well, experts tell Senate subcommittee
Telehealth coverage by Medicare is scheduled to expire at the end of 2024; experts told Senators what they think should happen to preserve it.
older woman on phone with credit card in hand
Health Lab
Health plays a role in older adults' vulnerability to scams
Most older adults have faced an attempted scam, and some have been defrauded, but rates were higher among those with health problems or disabilities.
wheelchair walker image
Health Lab
Spread of drug resistant bacteria linked to patient hand contamination and antibiotic use within nursing homes
A Michigan Medicine research team seeks to identify characteristics of patients within nursing homes, as well as the nursing home environment itself, that are associated with contamination by vancomycin-resistant enterococci.