OBJECTIVES: The American Cancer Society recommends regular screenings for breast and colorectal cancers for adults at average risk. Given clinical practice guideline updates and health care utilization changes following the COVID-19 pandemic, we characterized the distribution of cancer stage at diagnosis over the last decade in the United States (US) community oncology setting.

METHODS: Demographics and medical history data were sourced from structured data fields in iKnowMed™ (iKM), an oncology-specific electronic health record (EHR) system. Cancer stage at initial diagnosis was obtained from Clear Value Plus (CVP) platform, a clinical decision support tool embedded within the iKM system since 2014. All US Oncology Network practices that started using CVP prior to 1/1/2019 were included. Patients with the aforementioned two cancers identified between 2015 and 2023 were included.

RESULTS: The analysis included 270,581 patients, including 205,553 and 65,028 with breast and colorectal cancer, respectively. Overall, 96.5% of patients had available stage information, 85.8% were female, 70% were white, and mean ages were 60 and 63 years at diagnosis, respectively. The proportion of patients with Stage IV cancers increased over the study period from 12.0% to 20.0% for breast cancer and from 45.1% to 47.5% for colorectal cancer. From 2019 to 2020, there was an increase of >2% in the proportion of Stage IV disease for both cancers. For breast cancer, fewer women received an initial diagnosis (26,564 in 2019, 22,438 in 2020), largely driven by fewer early stage cancers.

CONCLUSIONS: Largely consistent with secular trends observed in national cancer registries, a greater proportion of advanced stage of disease at diagnosis was observed in this large community oncology network over the last decade, including more marked increases following the onset of the COVID19 pandemic. Trends discordant with national data likely reflect differences in referral patterns, treatments and other practice aspects specific to community settings.