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Chen HLR, Lee PP, Zhao Y, Ng WHC, Zhao J, Tan YEC, Loh BJS, Chow KHP, Tan HK, Tan KWE. The Impact of COVID-19 Pandemic on the Diagnosis, Treatment, and Outcomes of Colorectal Cancer in Singapore. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:138. [PMID: 39859120 PMCID: PMC11766542 DOI: 10.3390/medicina61010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 12/25/2024] [Accepted: 01/09/2025] [Indexed: 01/27/2025]
Abstract
Background and Objectives: During the COVID-19 pandemic, many countries implemented lockdowns and social distancing measures, which may delay the early diagnosis of colorectal cancer (CRC). This study aims to review the impact of the pandemic on the diagnosis and treatment outcomes of CRC. Materials and Methods: Patients who underwent colonoscopy or surgery for CRC were included. The study was divided into the pre-COVID-19 (January 2019-January 2020), early COVID-19 (February-May 2020), recovery (June-December 2020), and heightened alert (January-December 2021) periods. Cox regression was used to model the waiting time to colonoscopy. Multivariable logistic regression identified associations between time periods and incidence of CRC diagnosed. The characteristics and outcomes of the surgical procedures that were performed were compared across the time periods. Results: A total of 18,662 colonoscopies and 1462 surgical procedures were performed in the study period. Compared to the pre-COVID-19 period, there was a longer time to colonoscopy during the recovery (HR: 0.91; 95% CI: 0.87, 0.94) and heightened alert periods (HR: 0.88; 95% CI 0.85, 0.91). The early COVID-19 (OR: 1.36; 95% CI: 1.04, 1.77) and recovery (OR: 1.20; 95% CI: 1.01, 1.43) periods were associated with higher odds of diagnosing CRC. Compared to the pre-COVID-19 period, there was a higher proportion of ASA 4 patients (4.3% vs. 1.3%; p < 0.001) and stage 4 CRC patients (22.2% vs. 16.9%; p = 0.001) that required surgery during the heightened alert period. Similarly, there was a higher proportion of emergency surgeries (22% vs. 13.3%; p = 0.002); diverting stomas (13.5% vs. 10.5%; p = 0.005), and Hartmann's procedures (4.4% vs. 0.4%; p = 0.001) performed during the heightened alert period. Conclusions: The pandemic was associated with a higher proportion of metastatic CRC patients requiring surgery. Healthcare policies should facilitate early cancer screening, diagnosis, and treatment to reduce cancer-related morbidity for future pandemics.
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Affiliation(s)
- Hui Lionel Raphael Chen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Piea Peng Lee
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Group Finance Analytics, Singapore Health Services, Singapore 168753, Singapore
| | - Wei Hao Caleb Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Jiashen Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yu En Christopher Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Bo Jie Sean Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kah-Hoe Pierce Chow
- Duke-NUS Medical School, Singapore 169857, Singapore
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore 168582, Singapore
| | - Hiang Khoon Tan
- Duke-NUS Medical School, Singapore 169857, Singapore
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore 168582, Singapore
| | - Kwong-Wei Emile Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
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Galicia Pacheco SI, Catena A, Sánchez MJ, Rueda MDM, Aljarilla Sánchez L, Costas L, Garrido D, Garcia‐Retamero R, Espina C, Rodríguez‐Barranco M, Petrova D. Socio-Economic Inequalities in Beliefs About Cancer and its Causes: Evidence From two Population Surveys. Psychooncology 2024; 33:e70035. [PMID: 39625346 PMCID: PMC11613968 DOI: 10.1002/pon.70035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 10/15/2024] [Accepted: 11/17/2024] [Indexed: 12/06/2024]
Abstract
OBJECTIVE People's beliefs about cancer can affect the actions they take to prevent and detect the disease. We investigated socio-economic inequalities in beliefs about cancer and its causes in the general population. METHODS We analyzed data from the representative probabilistic Spanish Oncobarometer survey (N = 4769, 2020) and the non-probabilistic weight-corrected Spanish Cancer Awareness Survey (N = 1029, 2022). Beliefs about cancer, recognition of cancer symptoms, and recognition of risk factors were measured with the Awareness and Beliefs about Cancer questionnaire. Endorsement of mythical causes was measured with the CAM-Mythical Causes questionnaire. The effects of socio-economic status (SES) were investigated in multiple regression analyses adjusted for age, sex, and personal and family cancer history. RESULTS Individuals with lower SES were more likely to endorse pessimistic beliefs (e.g., "cancer is a death sentence"), and less likely to endorse optimistic beliefs about cancer (e.g., "people with cancer continue with normal activities"). Individuals with lower SES also recognized fewer cancer symptoms and risk factors and endorsed more mythical causes of cancer. The gap in knowledge regarding cancer causes was wider among people with low SES, who were more likely to endorse several mythical causes than some established risk factors included in cancer prevention recommendations. CONCLUSIONS Socio-economic inequalities in beliefs about cancer are robust and multidimensional and indicate worse preparedness to act against the disease among lower socio-economic groups. Differences in beliefs about disease outcomes and causes are likely one of the multiple contributors to cancer disparities and should be targeted and monitored in prevention efforts.
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Affiliation(s)
| | - Andrés Catena
- Faculty of PsychologyUniversity of GranadaGranadaSpain
| | - María José Sánchez
- Escuela Andaluza de Salud PúblicaGranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Maria del Mar Rueda
- Department of Statistics and Operational ResearchUniversity of GranadaGranadaSpain
| | | | - Laura Costas
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
- Cancer Epidemiology Research ProgrammeIDIBELL, Catalan Institute of OncologyBarcelonaSpain
| | - Dunia Garrido
- Faculty of PsychologyUniversity of GranadaGranadaSpain
| | | | - Carolina Espina
- Environment and Lifestyle Epidemiology BranchInternational Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Miguel Rodríguez‐Barranco
- Escuela Andaluza de Salud PúblicaGranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Dafina Petrova
- Escuela Andaluza de Salud PúblicaGranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
- Medical OncologyUniversity Hospital Virgen de las NievesGranadaSpain
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García-Alfonso P, Jimenez-Fonseca P, Soto-Alsar J, Baraibar I, Santos C, La Casta A, Ghanem I, Pulido Cortijo G, Mariño Méndez A, Pazo-Cid R, Vera R, Melián M, Alcaide J, Graña B, Páez D, Gallego I, Lobo M, Borregón M, Fernández Montes A, Martínez de Castro E, Carmona-Bayonas A, Aranda E. Three-year survival follow-up of patients with gastrointestinal cancer treated during the COVID-19 pandemic in Spain: data from the PANDORA-TTD20 study. Oncologist 2024:oyae300. [PMID: 39550209 DOI: 10.1093/oncolo/oyae300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 09/10/2024] [Indexed: 11/18/2024] Open
Abstract
INTRODUCTION The initial SARS-CoV-2 pandemic wave in Spain in 2020 precipitated significant paradigm shifts in gastrointestinal oncology patient management. This study captures the "Zeitgeist" of this period by analyzing adaptive strategies, treatment modifications, and survival outcomes, leveraging a 3-year follow-up perspective to extract insights from this unprecedented experience. METHODS We conducted a multicenter, retrospective cohort study utilizing the RETUD-TTD registry, encompassing 703 patients across 19 Spanish centers in April 2020. We evaluated alterations in clinical practice, therapeutic approaches, coronavirus disease 2019 (COVID-19)-related impacts, and patient survival. A Bayesian hierarchical model was employed to identify potential regional-specific frailties. RESULTS The peak of the pandemic in April 2020 catalyzed substantial shifts in oncological care delivery. Outpatient consultations decreased by 13%, with a notable selection bias toward cases with more favorable prognostic indicators. Multidisciplinary tumor board discussions were significantly curtailed (eg, mean monthly colorectal cancer cases discussed was reduced from 40 to 23), compromising qualitative care measures. This occurred concurrently with an average of over 3 oncologists per center on medical leave. Contrary to initial concerns, the healthcare system demonstrated remarkable resilience. The majority of patients received standard-of-care therapies with regulatory approval, albeit with regimen modifications in 15% of cases. These adaptations included extended dosing intervals, dose intensity modulations, and transitions to oral formulations while maintaining unexpectedly stable long-term survival outcomes. The Bayesian frailty model detected minimal unmeasured prognostic factors related to geographic location, and the type of pandemic-induced adaptation did not significantly impact survival. The model revealed that coronavirus disease 2019's impact was less pronounced than other core prognostic variables. CONCLUSIONS The decentralized Spanish healthcare system exhibited substantial robustness in managing pre-pandemic diagnosed gastrointestinal malignancies, despite asymmetrical, and occasionally severe organizational disruptions. The insights gleaned from this experience could inform future crisis preparedness strategies and optimize care provision during subsequent public health emergencies.
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Affiliation(s)
- Pilar García-Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, 28007, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias (HUCA), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, 33011, Spain
| | - Javier Soto-Alsar
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, 28007, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autónoma de Barcelona, CIBERONC, Barcelona, 08035, Spain
| | - Cristina Santos
- Medical Oncology Department, Institut Català d'Oncologia (ICO), Translational Research Laboratory, ICO-Bellvitge Biomedical Research Institute (IDIBELL)-CIBERONC, Barcelona, 08908, Spain
| | - Adelaida La Casta
- Medical Oncology Department, Hospital Universitario de Donostia, Guipúzcoa, 20014, Spain
| | - Ismael Ghanem
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, 28046, Spain
| | - Gema Pulido Cortijo
- Medical Oncology Department, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), CIBERONC, Instituto de Salud Carlos III (ISCIII), Córdoba, 14004, Spain
| | | | - Roberto Pazo-Cid
- Medical Oncology Department, Hospital Universitario Miguel Servet, Aragon Institute of Biomedical Research (IISA), Spanish Cancer Network (RTICC), ISCIII, Zaragoza, 50009, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, 31008, Spain
| | - Marcos Melián
- Medical Oncology Department, Instituto Valenciano de Oncología (IVO), Valencia, 46009, Spain
| | - Julia Alcaide
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, 29010, Spain
| | - Begoña Graña
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña (CHUA), Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, 15006, Spain
| | - David Páez
- Medical Oncology Department, Hospital Santa Creu i Sant Pau, Barcelona, 08041, Spain
| | - Inmaculada Gallego
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, 41013, Spain
| | - Miriam Lobo
- Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, 46014, Spain
| | - Miguel Borregón
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, 03203, Spain
| | - Ana Fernández Montes
- Medical Oncology Department, Complejo Hospitalario Universitario de Orense (CHUO), Orense, 32005, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Instituto De Investigación Marqués de Valdecilla (IDIVAL), Santander, 39008, Spain
| | - Alberto Carmona-Bayonas
- Medical Oncology Department, Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, 30008, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), CIBERONC, Instituto de Salud Carlos III (ISCIII), Córdoba, 14004, Spain
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Petrova D, Garrido D, Catena A, Ramírez-Hernández JA, Blakoe M, Fernández-Martínez NF, Pérez-Gómez B, Sánchez MJ, Garcia-Retamero R. Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study. Soc Sci Med 2024; 359:117263. [PMID: 39232381 DOI: 10.1016/j.socscimed.2024.117263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Reducing patient decision delay - the time elapsed between symptom onset and the moment the patient decides to seek medical attention - can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. METHODS We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. RESULTS Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DISCUSSION The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Dunia Garrido
- Faculty of Psychology, University of Granada, Spain.
| | | | - José Antonio Ramírez-Hernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Virgen de las Nieves University Hospital, Granada, Spain
| | - Mitti Blakoe
- Rigshospitalet, The Heart Center, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - María José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Akbari P, Nemati S, Nahvijou A, Bolourinejad P, Forbes L, Zendehdel K. Survey of awareness and beliefs about cancer (ABC) in Tehran Province, Iran. BMC Cancer 2024; 24:579. [PMID: 38734656 PMCID: PMC11088007 DOI: 10.1186/s12885-024-12211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Knowledge, attitudes, and practices are essential measures for planning and evaluating cancer control programs. Little is known about these in Iran. METHODS We conducted a population-based interview survey of adults aged 30-70 using the Farsi version of the Awareness and Beliefs about Cancer questionnaire in the capital province of Tehran, Iran, 2019. We calculated weighted estimates of levels of cancer knowledge, attitudes, and practices to allow for different selection probabilities and nonresponse. We used multivariate logistic regression to understand demographic factors associated with bowel, cervix, and breast screening practices. RESULTS We interviewed 736 men and 744 women. The mean number of recalled cancer warning signs was less than one; 57.7% could not recall any cancer warning signs. Participants recognized 5.6 out of 11 early cancer warning signs and 8.8 of 13 cancer risk factors. Most (82.7%) did not know that HPV infection was a cancer risk factor. Approximately, half had negative attitudes towards cancer treatment, but over 80% had positive attitudes towards the effectiveness of screening for improving survival. Colorectal, breast, and cervical screening rates were 24%, 42%, and 49%, respectively. Higher socioeconomic status increased the odds of taking up screening for cancer. Women aged 60-70 were less likely to report taking up breast and cervical screening than younger women. DISCUSSION The Iranian population has poor awareness and negative attitudes about cancer, and participation in screening programs is low. Public awareness and early detection of cancer should be promoted in Iran.
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Affiliation(s)
- Paria Akbari
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Nemati
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Bolourinejad
- Student Research Committee, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Petrova D, Pollán M, Garcia-Retamero R, Rodríguez-Barranco M, Catena A, Castillo Portellano L, Sánchez MJ. Cancer awareness in older adults: Results from the Spanish Onco-barometer cross-sectional survey. Int J Nurs Stud 2023; 140:104466. [PMID: 36871541 DOI: 10.1016/j.ijnurstu.2023.104466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived barriers among older adults. OBJECTIVES The goal of the current research was to investigate personal characteristics, perceived barriers, and beliefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. DESIGN Descriptive cross-sectional study. PARTICIPANTS Participants were 1213 older adults (≥65 years old) from the representative national Onco-barometer survey conducted in 2020 in Spain. METHODS Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Spanish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews. RESULTS Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was limited among males and older individuals. Respondents from lower socio-economic background recognized fewer cancer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and beliefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%-75%]), about what the doctor might find (21% increase [3%-43%]) and not having enough time to go to the doctor (30% increase [5%-60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%-33%]). CONCLUSIONS These results suggest that older adults could benefit from interventions informing them about how to reduce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. STUDY REGISTRATION Not registered.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | | | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Lucia Castillo Portellano
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; University Hospital Virgen de las Nieves, Granada, Spain
| | - Maria-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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7
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Mora N, Guiriguet C, Cantenys R, Méndez-Boo L, Marzo-Castillejo M, Benítez M, Fina F, Fàbregas M, Hermosilla E, Mercadé A, Medina M, Coma E. Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about 5 million people. Fam Pract 2023; 40:183-187. [PMID: 35861148 PMCID: PMC9384533 DOI: 10.1093/fampra/cmac083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the incidence of chronic disease had drastically been reduced due to health care interruptions. The aim of this study is to analyse cancer diagnosis during the last 2 years of the COVID-19 pandemic. METHODS Time-series study of cancer diagnoses recorded in primary care settings, using data from the primary care electronic health records from January 2014 to December 2021. We obtained the expected monthly rate per 100,000 inhabitants using a time regression adjusted by trend and seasonality. We additionally compared rates of cancer diagnoses in 2019 with those of 2020 and 2021 using the t-test. We performed the analysis globally, by sex and by type of cancer. RESULTS In 2020, the rate of cancer diagnoses had reduced by -21% compared to 2019 (P < 0.05). Greater reductions were observed during the lockdown in early 2020 (>40%) and with some types of cancers, especially prostate and skin cancers (-29.6% and -26.9%, respectively, P < 0.05). Lung cancers presented statistically non-significant reductions in both years. Cancer diagnosis returned to expected around March 2021, and the rate in 2021 was similar to that of 2019 (overall difference of 0.21%, P = 0.967). However, an 11% reduction was still found when comparing the pandemic months of 2020-2021 with pre-pandemic months. CONCLUSIONS Although primary care cancer diagnoses in 2021 have returned to pre-pandemic levels, missing diagnoses during the last 2 years have not been fully recovered.
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Affiliation(s)
- Núria Mora
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Equip d’Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Roser Cantenys
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mercè Marzo-Castillejo
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Direcció d’Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, Spain
| | - Mència Benítez
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Equip d’Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Albert Mercadé
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Manuel Medina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, Spain
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8
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Bosch X, Montori‐Palacin E, Martínez‐Ferrer R, Aldea A, Moreno P, López‐Soto A. Time intervals in the care pathway to cancer diagnosis during the COVID-19 pandemic: A large retrospective study from a high-volume center. Int J Cancer 2022; 152:384-395. [PMID: 36053784 PMCID: PMC9539134 DOI: 10.1002/ijc.34260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Despite extensive research on cancer care during the COVID-19 pandemic, evidence on the impact on prediagnostic time intervals is lacking. To better understand how COVID-19 changed the pathway to diagnosis of cancer, we examined the length of intervals from symptom onset to diagnosis for 13 common cancer types with known clinical stage over 1-year nonpandemic period (March 2019 to March 2020; N = 844) and three biannual COVID periods (March 2020 to September 2021; N = 1172). We analyzed the patient interval (from first symptoms to presentation to a physician), the primary care/emergency department interval (from presentation with relevant symptoms to a primary care or emergency department physician to referral to a hospital-based diagnosis center) and the hospital interval (from referral to diagnosis). Compared to nonpandemic data, there were significant changes across COVID periods. The pandemic mostly impacted patient intervals for cancers diagnosed over the first 6 months after onset in March 2020. Overall median patient intervals were longest in the early COVID period (39 [IQR 22-64] days) and shortest in the nonpandemic period (20 [IQR 13-30] days; Kruskal-Wallis test [χ2 ], P < .0001). Differences in clinical stage between periods were relevant, with cancers from the mid-period (September 2020 to March 2021) showing the most advanced stage. A shift to later stage was plausibly a result of delayed intervals in the early COVID period. Since intervals are eventually relevant to prognosis, our results provide a baseline against which the impact of improvement strategies to minimize the negative outcomes of COVID-19-associated cancer delays can be assessed and implemented.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Elisabet Montori‐Palacin
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
| | - Rosa Martínez‐Ferrer
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
| | - Anna Aldea
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Alfonso López‐Soto
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
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9
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Ip A, Black G, Vindrola-Padros C, Taylor C, Otter S, Hewish M, Bhuiya A, Callin J, Wong A, Machesney M, Fulop NJ, Taylor C, Whitaker KL. Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study. Br J Gen Pract 2022; 72:e472-e482. [PMID: 35636968 PMCID: PMC9256043 DOI: 10.3399/bjgp.2021.0644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND COVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes. AIM To understand how patients' help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES). DESIGN AND SETTING Qualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES. METHOD Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups. RESULTS Three themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients. CONCLUSION The findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.
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Affiliation(s)
- Athena Ip
- School of Health Sciences, University of Surrey, Guildford
| | - Georgia Black
- Department of Applied Health Research, University College London, London
| | | | - Claire Taylor
- London North West University Healthcare NHS Trust, London
| | - Sophie Otter
- Royal Surrey County Hospital NHS Foundation Trust, Guildford
| | | | - Afsana Bhuiya
- University College London Hospitals NHS Foundation Trust, London
| | - Julie Callin
- Bart's Health NHS Trust, The Royal Hospital, London
| | - Angela Wong
- Bart's Health NHS Trust, The Royal Hospital, London
| | | | - Naomi J Fulop
- Department of Applied Health Research, University College London, London
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford
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10
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Saab MM, O'Driscoll M, FitzGerald S, Sahm LJ, Leahy-Warren P, Noonan B, Kilty C, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. Primary healthcare professionals' perspectives on patient help-seeking for lung cancer warning signs and symptoms: a qualitative study. BMC PRIMARY CARE 2022; 23:119. [PMID: 35585504 PMCID: PMC9114293 DOI: 10.1186/s12875-022-01730-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer incidence and mortality worldwide. Prompt patient help-seeking for signs and symptoms suggestive of lung cancer is crucial for early referral, diagnosis, and survivorship. However, individuals with potential lung cancer symptoms tend to delay help-seeking. This qualitative study explored perceived barriers to patient help-seeking and strategies to enhance help-seeking for lung cancer warning signs and symptoms from the perspective of primary healthcare professionals. METHODS Semi-structured focus groups and individual interviews were conducted with 36 primary healthcare professionals. Data were collected via videoconferencing. Inductive thematic analysis was conducted. RESULTS The following two themes were created from the data: (i) perceived barriers to patient help-seeking for signs and symptoms of concern and (ii) facilitating early patient presentation for signs and symptoms of concern. Some participants believed that the high cost of a general practitioner visit, long waiting times, and previous bad experiences with the healthcare system would deter patients from seeking help for symptoms of lung cancer. Perceived patient-related barriers to help-seeking related to the different emotions associated with a potential cancer diagnosis as well as stigma, embarrassment, and guilt felt by smokers. Sociodemographic factors such as drug use, homelessness, living in rural areas, and being male and older were also perceived to impede patient help-seeking. The negative impact of the COVID-19 pandemic on cancer help-seeking also featured strongly. Participants recommended several strategies to enable patients to seek help for symptoms of concern including targeted educational campaigns focussing on symptoms (e.g., cough) rather than behaviours (e.g., smoking), accessible and free health services, and using patients' support networks. CONCLUSIONS Patient-related and healthcare system-related barriers to help-seeking for lung cancer warning signs and symptoms include cost of healthcare, cancer fear, and various sociodemographic factors. Participants suggested that increased awareness and early patient help-seeking for symptoms of concern could be achieved through targeted patient education, national campaigns, the use of community support networks, and free and accessible targeted screening services.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland.
| | - Michelle O'Driscoll
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
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11
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Malagón T, Yong JHE, Tope P, Miller WH, Franco EL, McGill Task Force on the Impact of COVID‐19 on Cancer Control and Care. Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada. Int J Cancer 2022; 150:1244-1254. [PMID: 34843106 PMCID: PMC9015510 DOI: 10.1002/ijc.33884] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic has affected cancer care worldwide. This study aimed to estimate the long-term impacts of cancer care disruptions on cancer mortality in Canada using a microsimulation model. The model simulates cancer incidence and survival using cancer incidence, stage at diagnosis and survival data from the Canadian Cancer Registry. We modeled reported declines in cancer diagnoses and treatments recorded in provincial administrative datasets in March 2020 to June 2021. Based on the literature, we assumed that diagnostic and treatment delays lead to a 6% higher rate of cancer death per 4-week delay. After June 2021, we assessed scenarios where cancer treatment capacity returned to prepandemic levels, or to 10% higher or lower than prepandemic levels. Results are the median predictions of 10 stochastic simulations. The model predicts that cancer care disruptions during the COVID-19 pandemic could lead to 21 247 (2.0%) more cancer deaths in Canada in 2020 to 2030, assuming treatment capacity is recovered to 2019 prepandemic levels in 2021. This represents 355 172 life years lost expected due to pandemic-related diagnostic and treatment delays. The largest number of expected excess cancer deaths was predicted for breast, lung and colorectal cancers, and in the provinces of Ontario, Québec and British Columbia. Diagnostic and treatment capacity in 2021 onward highly influenced the number of cancer deaths over the next decade. Cancer care disruptions during the COVID-19 pandemic could lead to significant life loss; however, most of these could be mitigated by increasing diagnostic and treatment capacity in the short-term to address the service backlog.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontrealQuebecCanada
- Department of OncologyMcGill UniversityMontrealQuebecCanada
| | | | - Parker Tope
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontrealQuebecCanada
| | | | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontrealQuebecCanada
- Department of OncologyMcGill UniversityMontrealQuebecCanada
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12
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Del Cura-González I, Polentinos-Castro E, Fontán-Vela M, López-Rodríguez JA, Martín-Fernández J. [What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S36-S43. [PMID: 35781146 PMCID: PMC9244613 DOI: 10.1016/j.gaceta.2022.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 pandemic and the associated public health emergency have affected patients and health services in non-COVID-19 pathologies. Several studies have shown its dissociation from health services, with a decrease in emergency department visits, in hospital admissions for non-COVID-19 pathologies, as well as in the reported weekly incidence of acute illnesses and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties in accessing health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats has reduced the capacity to prevent or control chronic diseases. All this has also had an impact on the different areas of people's lives, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have changed with each epidemic wave. We present a review of the most relevant studies that have been analyzing this problem and incorporate as a case study the results of a retrospective observational study carried out in Primary Care in the Madrid Health Service, which provides health coverage to a population of more than 6 million people, and whose objective was to analyze the loss of new diagnoses in the most prevalent pathologies such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease, and breast and colon tumors, in the first and second waves. Annual incidence rates with their confidence interval were calculated for each pathology and the monthly frequency of new codes recorded between 1/01/2020 and 12/31/2020 was compared with the monthly mean of observed counts for the same months between 2016 and 2019. The annual incidence rate for all processes studied decreased in 2020 except for anxiety disorders. Regarding the recovery of lost diagnoses, heart failure is the only diagnosis showing an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and follow-up of non-COVID-19 pathology, the healthcare system must reorganize and contemplate specific actions for the groups at highest risk.
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Affiliation(s)
- Isabel Del Cura-González
- Unidad de Investigación, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) - Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España.
| | - Elena Polentinos-Castro
- Unidad de Investigación, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) - Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Mario Fontán-Vela
- Servicio de Medicina Preventiva, Hospital Infanta Leonor, Madrid, España; Grupo de Investigación en Salud Pública y Epidemiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Juan A López-Rodríguez
- Unidad de Investigación, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) - Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Centro de Salud General Ricardos, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Jesús Martín-Fernández
- Departamento de Especialidades Médicas y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) - Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España; Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, España
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13
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Delays in Cancer Diagnostic Testing at a Quick Referral Unit in Spain during COVID-19. Diagnostics (Basel) 2021; 11:diagnostics11112096. [PMID: 34829441 PMCID: PMC8623804 DOI: 10.3390/diagnostics11112096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
Although COVID-19 has had dire consequences on diagnosis of cancer, little data assessing its impact on the whole range of diagnostic activity relevant to cancer are available. We examined trends in the provision of full diagnostic tests for consecutive patients with suspected cancer referred to an academic hospital-based Quick Diagnosis Unit from January 2019 to December 2020. As weekly volumes declined, waiting times for endoscopic, imaging and biopsy/cytology procedures increased steeply during the COVID-impacted period (26 February-28 April 2020). The average weekly increase compared with the same period in 2019 was substantial for invasive procedures requiring admission (200.70%), CT scans (171.20%), GI endoscopy (161.50%), PET/CT scans (152.50%), ultrasonography (148.40%), and ambulatory biopsy/cytology procedures (111.20%). Volumes and waiting times to other procedures showed similar trends. There was a remarkable downward trend in cancer diagnosis during the COVID-impacted period, with a 54.07% reduction compared with the same weeks in 2019. Despite a modest recovery in the following months, the decline in weekly activity and cancer rates persisted until 30 December. Providing insight into how COVID-19 changed the full spectrum of diagnostic activity for suspected cancer informs resilience-building interventions to guarantee access to fast and efficient diagnostics ahead of new threats.
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14
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Petrova D, Borrás JM, Pollán M, Bayo Lozano E, Vicente D, Jiménez Moleón JJ, Sánchez MJ. Public Perceptions of the Role of Lifestyle Factors in Cancer Development: Results from the Spanish Onco-Barometer 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910472. [PMID: 34639771 PMCID: PMC8507999 DOI: 10.3390/ijerph181910472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
The European Code against Cancer recommends not to smoke, to avoid alcohol consumption, to eat a healthy diet, and maintain a healthy weight to prevent cancer. To what extent is the public aware of the influence of these lifestyle factors on cancer development? The goal of the current study was to describe the perceived influence of four lifestyle factors (tobacco, alcohol, diet, and weight) on cancer development in the general population and identify factors related to low perceptions of influence. We analyzed data from the 2020 Onco-barometer (n = 4769), a representative population-based survey conducted in Spain. With the exception of smoking, lifestyle factors were among those with the least perceived influence, more so among the demographic groups at higher risk from cancer including men and older individuals (65+ years). Individuals from lower socio-economic groups were more likely to report not knowing what influence lifestyle factors have on cancer. Lower perceived influence was also consistently related to perceiving very low risk from cancer. Overall, although there is variation in perceptions regarding the different lifestyle factors, low perceived influence clusters among those at higher risk for cancer. These results signal the need for public health campaigns and messages informing the public about the preventive potential of lifestyle factors beyond avoiding tobacco consumption.
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Affiliation(s)
- Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.P.); (J.J.J.M.); (M.J.S.)
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Correspondence:
| | - Josep Maria Borrás
- Department of Clinical Sciences, University of Barcelona, 08908 Barcelona, Spain;
- Bellvitge Biomedical Research Institute, 08908 Hospitalet, Spain
- NHS Cancer Strategy, Ministry of Health, 28046 Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.P.); (J.J.J.M.); (M.J.S.)
- National Center for Epidemiology, Health Institute Carlos III, 28029 Madrid, Spain
| | - Eloísa Bayo Lozano
- University Hospital Virgen Macarena, 41009 Seville, Spain; (E.B.L.); (D.V.)
| | - David Vicente
- University Hospital Virgen Macarena, 41009 Seville, Spain; (E.B.L.); (D.V.)
| | - José Juan Jiménez Moleón
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.P.); (J.J.J.M.); (M.J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18010 Granada, Spain
| | - Maria José Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.P.); (J.J.J.M.); (M.J.S.)
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18010 Granada, Spain
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15
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Quinn-Scoggins HD, Cannings-John R, Moriarty Y, Whitelock V, Whitaker KL, Grozeva D, Hughes J, Townson J, Osborne K, Goddard M, McCutchan GM, Waller J, Robling M, Hepburn J, Moore G, Gjini A, Brain K. Cancer symptom experience and help-seeking behaviour during the COVID-19 pandemic in the UK: a cross-sectional population survey. BMJ Open 2021; 11:e053095. [PMID: 34531224 PMCID: PMC8449845 DOI: 10.1136/bmjopen-2021-053095] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To understand self-reported potential cancer symptom help-seeking behaviours and attitudes during the first 6 months (March-August 2020) of the UK COVID-19 pandemic. DESIGN UK population-based survey conducted during August and September 2020. Correlates of help-seeking behaviour were modelled using logistic regression in participants reporting potential cancer symptoms during the previous 6 months. Qualitative telephone interviews with a purposeful subsample of participants, analysed thematically. SETTING Online UK wide survey. PARTICIPANTS 7543 adults recruited via Cancer Research UK online panel provider (Dynata) and HealthWise Wales (a national register of 'research ready' participants) supplemented with social media (Facebook and Twitter) recruitment. 30 participants were also interviewed. MAIN OUTCOME MEASURES Survey measures included experiences of 15 potential cancer symptoms, help-seeking behaviour, barriers and prompts to help-seeking. RESULTS Of 3025 (40.1%) participants who experienced a potential cancer symptom, 44.8% (1355/3025) had not contacted their general practitioner (GP). Odds of help-seeking were higher among participants with disability (adjusted OR (aOR)=1.38, 95% CI 1.11 to 1.71) and who experienced more symptoms (aOR=1.68, 95% CI 1.56 to 1.82), and lower among those who perceived COVID-19 as the cause of symptom(s) (aOR=0.36, 95% CI 0.25 to 0.52). Barriers included worries about wasting the doctor's time (1158/7543, 15.4%), putting strain on healthcare services (945, 12.6%) and not wanting to make a fuss (907, 12.0%). Interviewees reported reluctance to contact the GP due to concerns about COVID-19 and fear of attending hospitals, and described putting their health concerns on hold. CONCLUSIONS Many people avoided healthcare services despite experiencing potential cancer symptoms during the COVID-19 pandemic. Alongside current help-seeking campaigns, well-timed and appropriate nationally coordinated campaigns should signal that services are open safely for those with unusual or persistent symptoms. TRIAL REGISTRATION NUMBER ISRCTN17782018.
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Affiliation(s)
- Harriet D Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Grace M McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ardiana Gjini
- Public Health Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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