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Bilsbury E, Mautner Wizentier M, Wood E, Doherty S, Ledwith J, Ding J. The Continuing Impact of the COVID-19 Pandemic on Diabetic Retinopathy Screenings. Ophthalmic Epidemiol 2024:1-7. [PMID: 39083570 DOI: 10.1080/09286586.2024.2372045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 04/08/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE This retrospective observational study of health claims data seeks to quantify the prolonged impact of the COVID-19 pandemic on DR screening rates in central Massachusetts. METHODS Retrospective claims data from the UMass Memorial Managed Care Network were collected for the years of 2018-2022. Comprehensive and DR screening exams were identified using CPT codes for patients with diabetes. Data were derived from claims submitted by the UMass Memorial Managed Care network to four insurance programs via CPT billing code for comprehensive and DR screening exams for patients with diabetes. Over one million claims for the years 01/2018-05/2022 were collected. RESULTS We found a significant decrease in unadjusted DR screening rates in the post-lockdown period compared to the pre-COVID-19 period (p < 0.001). Bivariate analysis revealed a 15.1% decrease in weekly DR screenings during post-lockdown (RR = 0.849, 95% CI = 0.811, 0.888). After adjusting for seasonal variation, the mean weekly DR screening rate was 12% lower in the post-lockdown period, with a 95% CI of 6.1% to 17.5% decrease (Adjusted RR = 0.880, 95% CI = 0.825, 0.939 Stratified analysis based on patient status revealed a significant decrease in adjusted DR screening rates for established patients post-lockdown compared to pre-pandemic (p < 0.0001), while no significant difference was observed for new patients (p > 0.05). CONCLUSION The impact of COVID-19 on DR screening and treatment rates persisted even after the resumption of non-essential care services, with a discrepancy between new and established patients. Future research should work to identify and overcome the barriers to DR screening.
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Affiliation(s)
- Evan Bilsbury
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Marina Mautner Wizentier
- Department of Biostatistics, New York University School of Global Public Health, New York, New York, USA
| | - Emma Wood
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sean Doherty
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - James Ledwith
- Department of Family Medicine and Community Health, University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts, USA
| | - Juan Ding
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Alkhaifi S. "I Trust That Only God Can Protect Me, But …": The Religious Meaning Behind Mammogram Attitudes and Behaviors Among Immigrant Muslim Women. J Immigr Minor Health 2024; 26:546-553. [PMID: 37980314 DOI: 10.1007/s10903-023-01567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/20/2023]
Abstract
Although breast cancer is the second leading cause of death among women in the United States, women from ethnic minorities still underutilize mammogram screenings. Immigrant Muslim women (IMW) demonstrated low mammogram screening rates compared to the national target of 77.1% determined by Healthy People 2030. Although IMW comprise an understudied population in the health field, a limited number of studies have proposed that Islamic religious beliefs have an impact on their behaviors and practices in regard to mammogram use. This study aimed to understand the meanings IMW ascribe to their religious beliefs in relation to mammogram utilization. A qualitative thematic analysis study was conducted on a purposive sample. A total of 28 IMW were recruited for one-on-one interviews in either Arabic or English, and inductive thematic analysis as per Braun and Clarke (2008) informed data analysis, guided by symbolic interactionism. A total of 28 interviews (10 in English and 18 in Arabic) were conducted with IMW whose mean age was 54.7. During these interviews, three major themes emerged regarding the participants' experience with mammograms, within the context of their religious beliefs: (a) 'Your body is a trust,' (b) the notions of al-tawakkul and al-tawaakoul, and (c) religious methods for coping with mammogram use. Results from this study suggests some religious means that can be integrated into an educational program designed for IMW to enhance their mammogram screening rates.
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Affiliation(s)
- Sarah Alkhaifi
- Department of Maternity and Childhood Nursing, School of Nursing, King Abdulaziz University, P.O. Box 80200, 21589, Jeddah, Kingdom of Saudi Arabia.
- Initiative On Islam and Medicine, Brookfield, WI, USA.
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Wang H, Yang M, Xiong W, Wang Q, Zheng B, Bai Y, Zou K, Li J, Ren J, Chen W, Zhai J, Li J. Noteworthy impacts of COVID-19 pandemic on cancer screening: A systematic review. FUNDAMENTAL RESEARCH 2024; 4:484-494. [PMID: 38933198 PMCID: PMC11197616 DOI: 10.1016/j.fmre.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 06/28/2024] Open
Abstract
The sudden onset of the coronavirus disease 2019 (COVID-19) in January 2020 has affected essential global health services. Cancer-screening services that can reduce cancer mortality are strongly affected. However, the specific role of COVID-19 in cancer screening is not fully understood. This study aimed to assess the efficiency of global cancer screening programs before and during the COVID-19 pandemic and to promote potential cancer-screening strategies for the next pandemic. Electronic searches in PubMed, Embase, and Web of Science, and manual searches were performed between January 1, 2020 and March 1, 2023. Cohort studies that reported the number of participants who underwent cancer screening before and during the COVID-19 pandemic were included. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Differences in cancer-screening rates were estimated using the incidence rate ratio (IRR). Fifty-five cohort studies were included in this meta-analysis. The screening rates of colorectal cancer using invasive screening methods (Pooled IRR = 0.52, 95% CI: 0.42 to 0.65, p < 0.01), cervical cancer (Pooled IRR = 0.56, 95% CI: 0.47 to 0.67, p < 0.01), breast cancer (Pooled IRR = 0.57, 95% CI: 0.49 to 0.66, p < 0.01) and prostate cancer (Pooled IRR = 0.71, 95% CI: 0.56 to 0.90, p < 0.01) during the COVID-19 pandemic were significantly lower than those before the COVID-19 pandemic. The screening rates of lung cancer (Pooled IRR = 0.77, 95% CI: 0.58 to 1.03, p = 0.08) and colorectal cancer using noninvasive screening methods (Pooled IRR = 0.74, 95% CI: 0.50 to 1.09, p = 0.13) were reduced with no statistical differences. The subgroup analyses revealed that the reduction in cancer-screening rates varied across economies. Our results suggest that the COVID-19 pandemic has had a noteworthy impact on colorectal, cervical, breast, and prostate cancer screening. Developing innovative cancer-screening technologies is important to promote the efficiency of cancer-screening services in the post-COVID-19 era and prepare for the next pandemic.
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Affiliation(s)
- Huilin Wang
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Min Yang
- Department of Comprehensive Intervention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Xiong
- Department of Gynecology Endocrine & Reproductive Center, National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Quan Wang
- Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi'an 710068, China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’ s Hospital, Xi'an 710068, China
| | - Yang Bai
- College of Clinical Medicine, Capital Medical University, Beijing 100069, China
| | - Kaiyong Zou
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jibin Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiansong Ren
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingbo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jiang Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Nyante SJ, Deal AM, Heiling HM, Kim KS, Kuzmiak CM, Calhoun BC, Ray EM. Trends in breast, colon, pancreatic, and uterine cancers in women during the COVID-19 pandemic in North Carolina. Cancer Med 2024; 13:e7156. [PMID: 38572934 PMCID: PMC10993709 DOI: 10.1002/cam4.7156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
IMPORTANCE The COVID-19 pandemic led to reductions in primary care and cancer screening visits, which may delay detection of some cancers. The impact on incidence has not been fully quantified. We examined change in cancer incidence to determine how the COVID-19 pandemic may have altered the characteristics of cancers diagnosed among women. METHODS This study included female patients aged ≥18 years and diagnosed with breast (n = 9489), colon (n = 958), pancreatic (n = 669), or uterine (n = 1991) cancer at three hospitals in North Carolina. Using interrupted time series, we compared incidence of cancers diagnosed between March 2020 and November 2020 (during pandemic) with cancers diagnosed between January 2016 and February 2020 (pre-pandemic). RESULTS During the pandemic, incidence of breast and uterine cancers was significantly lower than expected compared to pre-pandemic (breast-18%, p = 0.03; uterine -20%, p = 0.05). Proportions of advanced pathologic stage and hormone receptor-negative breast cancers, and advanced clinical stage and large size uterine cancers were more prevalent during the pandemic. No significant changes in incidence were detected for pancreatic (-20%, p = 0.08) or colon (+14%, p = 0.30) cancers. CONCLUSION AND RELEVANCE In women, the COVID-19 pandemic resulted in a significant reduction in the incidence of breast and uterine cancers, but not colon or pancreatic cancers. A change in the proportion of poor prognosis breast and uterine cancers suggests that some cancers that otherwise would have been diagnosed at an earlier stage will be detected in later years. Continued analysis of long-term trends is needed to understand the full impact of the pandemic on cancer incidence and outcomes.
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Affiliation(s)
- Sarah J. Nyante
- Department of RadiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Allison M. Deal
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kyung Su Kim
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Cherie M. Kuzmiak
- Department of RadiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Benjamin C. Calhoun
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Pathology and Laboratory MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Emily M. Ray
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Division of Oncology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Cohen EO, Edelkamp P, Sun J, Leung JWT. Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic. J Am Coll Radiol 2024; 21:576-588. [PMID: 37952808 DOI: 10.1016/j.jacr.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center. METHODS This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach. RESULTS A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations. DISCUSSION At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.
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Affiliation(s)
- Ethan O Cohen
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Paul Edelkamp
- Division of Information Services, Enterprise Data Engineering, and Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica W T Leung
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Santos T, Bergman A, Smith-McLallen A. Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus. JAMA Netw Open 2024; 7:e248519. [PMID: 38669019 PMCID: PMC11053373 DOI: 10.1001/jamanetworkopen.2024.8519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure Receipt of care at a practice participating in CPC+. Main Outcomes and Measures Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.
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Affiliation(s)
- Tatiane Santos
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Alon Bergman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia
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Barclay NL, Pineda Moncusí M, Jödicke AM, Prieto-Alhambra D, Raventós B, Newby D, Delmestri A, Man WY, Chen X, Català M. The impact of the UK COVID-19 lockdown on the screening, diagnostics and incidence of breast, colorectal, lung and prostate cancer in the UK: a population-based cohort study. Front Oncol 2024; 14:1370862. [PMID: 38601756 PMCID: PMC11004443 DOI: 10.3389/fonc.2024.1370862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The COVID-19 pandemic had collateral effects on many health systems. Cancer screening and diagnostic tests were postponed, resulting in delays in diagnosis and treatment. This study assessed the impact of the pandemic on screening, diagnostics and incidence of breast, colorectal, lung, and prostate cancer; and whether rates returned to pre-pandemic levels by December, 2021. Methods This is a cohort study of electronic health records from the United Kingdom (UK) primary care Clinical Practice Research Datalink (CPRD) GOLD database. The study included individuals registered with CPRD GOLD between January, 2017 and December, 2021, with at least 365 days of clinical history. The study focused on screening, diagnostic tests, referrals and diagnoses of first-ever breast, colorectal, lung, and prostate cancer. Incidence rates (IR) were stratified by age, sex, and region, and incidence rate ratios (IRR) were calculated to compare rates during and after lockdown with rates before lockdown. Forecasted rates were estimated using negative binomial regression models. Results Among 5,191,650 eligible participants, the first lockdown resulted in reduced screening and diagnostic tests for all cancers, which remained dramatically reduced across the whole observation period for almost all tests investigated. There were significant IRR reductions in breast (0.69 [95% CI: 0.63-0.74]), colorectal (0.74 [95% CI: 0.67-0.81]), and prostate (0.71 [95% CI: 0.66-0.78]) cancer diagnoses. IRR reductions for lung cancer were non-significant (0.92 [95% CI: 0.84-1.01]). Extrapolating to the entire UK population, an estimated 18,000 breast, 13,000 colorectal, 10,000 lung, and 21,000 prostate cancer diagnoses were missed from March, 2020 to December, 2021. Discussion The UK COVID-19 lockdown had a substantial impact on cancer screening, diagnostic tests, referrals, and diagnoses. Incidence rates remained significantly lower than pre-pandemic levels for breast and prostate cancers and associated tests by December, 2021. Delays in diagnosis are likely to have adverse consequences on cancer stage, treatment initiation, mortality rates, and years of life lost. Urgent strategies are needed to identify undiagnosed cases and address the long-term implications of delayed diagnoses.
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Affiliation(s)
- Nicola L. Barclay
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Marta Pineda Moncusí
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Annika M. Jödicke
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Daniel Prieto-Alhambra
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
| | - Berta Raventós
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Danielle Newby
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Antonella Delmestri
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Wai Yi Man
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Xihang Chen
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Marti Català
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
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Hanuschak D, DePiero M, DeMoraes M, Bailly S, Rubens M, Lindeman P, Zinner M, Young G. The impact of COVID-19 on patients diagnosed with melanoma, breast, and colorectal cancer. Am J Surg 2024; 229:36-41. [PMID: 37798149 DOI: 10.1016/j.amjsurg.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted healthcare resource allocation and utilization of preventative medical services. It is unknown if there is resultant stage migration of melanoma, breast, and colorectal cancer when comparing extended time periods before and after the pandemic onset. METHODS A retrospective cohort study of melanoma, breast, and colorectal cancer patients was completed. Clinical and pathological staging was compared utilizing 12 and 22-month timeframes before and after the pandemic outbreak. RESULTS Between the 22-month pre- and post-COVID-19 groups, breast cancer clinical stage T2 significantly increased, and pathological stage 2 decreased. Colorectal cancer clinical stage T1 decreased, stage T4 increased, and stage 0 decreased in the 22-month groups. In the 12-month groups, melanoma clinical stage T1 increased, and colorectal cancer clinical stage N2 increased. CONCLUSIONS Evaluating extended timeframes beyond the immediate pre- and post-COVID-19 period revealed significant increases in clinical staging of breast and colorectal cancer, suggesting advanced disease is becoming more evident as time progresses.
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Affiliation(s)
- Danielle Hanuschak
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Mallori DePiero
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Melissa DeMoraes
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Shamoore Bailly
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Paul Lindeman
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Michael Zinner
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA; Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
| | - Geoffrey Young
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA; Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Drive, Miami, FL, 33176, USA.
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Decker KM, Musto G, Bucher O, Czaykowski P, Hebbard P, Kim JO, Singh H, Thiessen M, Feely A, Galloway K, Lambert P. Examining the Association Between the COVID-19 Pandemic and the Rate of Diagnostic Tests for Breast, Cervical, and Colorectal Cancer in Manitoba, Canada. Technol Cancer Res Treat 2024; 23:15330338241263616. [PMID: 39053019 PMCID: PMC11282542 DOI: 10.1177/15330338241263616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/02/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background: Strategies to minimize the impact of the COVID-19 pandemic led to a reduction in diagnostic testing. It is important to assess the magnitude and duration of this impact to plan ongoing care and avoid long-lasting impacts of the pandemic. Objective: We examined the association between the COVID-19 pandemic and the rate of diagnostic tests for breast, cervical, and colorectal cancer in Manitoba, Canada. Design and Participants: A population-based, cross-sectional study design with an interrupted time series analysis was used that included diagnostic tests from January 1, 2015 until August 31, 2022. Setting: Manitoba, Canada. Main Outcomes: Outcomes included mammogram, breast ultrasound, colposcopy, and colonoscopy rates per 100,000. Cumulative and percent cumulative differences between the fitted and counterfactual number of tests were estimated. Mean, median, and 90th percentile number of days from referral to colonoscopy date by referral type (elective, semiurgent, urgent) were determined. Results: In April 2020, following the declaration of the COVID-19 public health emergency, bilateral mammograms decreased by 77%, unilateral mammograms by 70%, breast ultrasounds by 53%, colposcopies by 63%, and colonoscopies by 75%. In Winnipeg (the largest urban center in the province), elective and semiurgent colonoscopies decreased by 76% and 39%, respectively. There was no decrease in urgent colonoscopies. As of August 2022, there were an estimated 7270 (10.7%) fewer bilateral mammograms, 2722 (14.8%) fewer breast ultrasounds, 836 (3.3%) fewer colposcopies, and 11 600 (13.8%) fewer colonoscopies than expected in the absence of COVID-19. As of December 2022, in Winnipeg, there were an estimated 6030 (23.9%) fewer elective colonoscopies, 313 (2.6%) fewer semiurgent colonoscopies, and 438 (27.3%) more urgent colonoscopies. Conclusions: In Manitoba, the COVID-19 pandemic was associated with sizable decreases in diagnostic tests for breast, colorectal, and cervical cancer. Two and a half years later, there remained large cumulative deficits in bilateral mammograms, breast ultrasounds, and colonoscopies.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Grace Musto
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
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10
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Amato O, Guarneri V, Girardi F. Epidemiology trends and progress in breast cancer survival: earlier diagnosis, new therapeutics. Curr Opin Oncol 2023; 35:612-619. [PMID: 37681462 PMCID: PMC10566595 DOI: 10.1097/cco.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW In this review we will critically appraise the latest evidence on breast cancer (BC) survival trends and discuss how these may reflect breakthroughs in early diagnosis and treatment approaches. We will address the wide global inequalities in BC survival and review the ongoing initiatives aimed at improving cancer control worldwide. RECENT FINDINGS BC outcomes have improved in high-income countries during the last decades, following the implementation of strategies for early detection and optimal multimodality treatment. Novel therapeutics, such as anti-HER2 targeted treatments, have also contributed to the progress in BC survival. However, BC mortality is still high in low-income countries, due to the lack of optimal healthcare infrastructures. In the context of marked inequities in BC management across world regions, international collaborations such as the Global Breast Cancer Initiative and the Global Initiative for Cancer Registry Development work to foster capacity-building in developing countries, tackle the burden of BC and deliver the Sustainable Development Goals by 2030. SUMMARY Collection of robust, high-quality data from population-based cancer registries is crucial to drive and refine public health interventions. Population-based data are also the litmus paper to evaluate the real-world impact of clinical advances and monitor progress.
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Affiliation(s)
- Ottavia Amato
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Fabio Girardi
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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11
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De Sarro C, Papadopoli R, Morgante MC, Pileggi C. A new emergency during the latest phase of the COVID-19 pandemic: access to healthcare services by patients with non-communicable diseases. Front Med (Lausanne) 2023; 10:1261063. [PMID: 37901416 PMCID: PMC10602673 DOI: 10.3389/fmed.2023.1261063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background The aim of our study was to investigate the impact of the COVID-19 pandemic on the healthcare and the disease management of patients affected by non-communicable diseases (NCDs), by exploring, specifically, the obstacles encountered in the access to healthcare services during the latest phase of the pandemic. Methods This cross-sectional study was carried out among subjects attending the anti-SARS-CoV2 vaccination clinic in a Teaching Hospital of Southern Italy. To be included in the study, subjects had to be affected by at least one NCD, such as diabetes, hypertension, respiratory and heart diseases, renal and liver chronic conditions, immunodeficiency disorders due to cancer, or being kidney or liver transplant recipients. Results Among the 553 subjects who completed the questionnaire, the 39.4% (95% IC = 35.3-43.6) experienced obstacles in the access to healthcare services in the six months prior to the enrollment. The most frequent canceled/postponed healthcare services were the visits for routine checks for NCDs (60.6, 95% IC = 53.9-67), control visits of more complex diseases as cancer or transplantation (17.3, 95% IC = 12.6-22.8), and scheduled surgery (11.5, 95% IC = 7.7-16.4). The patients who experienced canceled/postponed healthcare services were significantly more likely to suffer from 3 or more NCDs (p = 0.042), to be diabetics (p = 0.038), to have immunodeficiency disorders (p = 0.028) and to have consulted GP at least once (p = 0.004). Conclusion Our results appear to be fundamental for guiding the choices of providers in order to concentrate organizational efforts to recover and reschedule missed appointments, where applicable, of the most fragile patients by virtue of age and chronic conditions.
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Affiliation(s)
- Caterina De Sarro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
- FAS@UMG Research Center, Department of Health Science, School of Medicine, University of Catanzaro, Catanzaro, Italy
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12
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Chung SH, Romatoski KS, Rasic G, Beaulieu-Jones BR, Kenzik K, Merrill AL, Tseng JF, Cassidy MR, Sachs TE. Impact of the COVID-19 Pandemic on Delays to Breast Cancer Surgery: Ripples or Waves? Ann Surg Oncol 2023; 30:6093-6103. [PMID: 37526751 DOI: 10.1245/s10434-023-13878-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Adherence to current recommendations for optimal time from diagnosis to treatment for patients with breast cancer may have been disrupted by the COVID-19 pandemic. This study aimed to evaluate the impact of the pandemic on time to surgery or systemic treatment with chemotherapy or immunotherapy for patients diagnosed with breast cancer. METHODS Using the National Cancer Database, patients diagnosed with breast cancer in 2020 were compared to those diagnosed from 2018-2019 (Pre-COVID). Sub-analyses were performed for patients who were tested for COVID-19 and those who had a positive result in 2020. Multivariate logistic regression was used assess odds ratios for delayed time to surgery (DTS, defined as > 90 days) or systemic therapy (defined as > 120 days). RESULTS In total, 230,997 patients were diagnosed with breast cancer in 2018 and 2019 compared to 102,065 in 2020. Of the 2020 cohort, 47,659 (46.7%) received COVID-19 testing; of which, 3,158 (6.6%) resulted positive. A larger proportion of COVID-tested or COVID-positive patients had higher stage at diagnosis. DTS was more likely for patients who were diagnosed in 2020, uninsured or underinsured, non-white, Hispanic, less educated, or age < 70 years. Similar factors were predictive of delay to systemic therapy (less age < 70 years); however, diagnosis in 2020 was not. CONCLUSION The COVID-19 pandemic was associated with significant DTS for breast cancer but spared time to systemic therapy. Delays disproportionately impacted vulnerable and underserved patient populations. The true clinical effects of these delays may yet be realized for breast cancer patients.
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Affiliation(s)
- Sophie H Chung
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kelsey S Romatoski
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Gordana Rasic
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea L Merrill
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael R Cassidy
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Section of Surgical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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13
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Star J, Bandi P, Siegel RL, Han X, Minihan A, Smith RA, Jemal A. Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic. J Clin Oncol 2023; 41:4352-4359. [PMID: 36821800 PMCID: PMC10911528 DOI: 10.1200/jco.22.02170] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions. [Media: see text].
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Affiliation(s)
- Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Rebecca L. Siegel
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Adair Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Early Cancer Detection Science Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
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14
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Romatoski KS, Chung SH, Kenzik K, Rasic G, Ng SC, Tseng JF, Sachs TE. Delay and Disparity in Observed vs Predicted Incidence Rate of Screenable Cancer During the COVID-19 Pandemic. J Am Coll Surg 2023; 237:420-430. [PMID: 37227063 DOI: 10.1097/xcs.0000000000000772] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in disruption of healthcare services, including cancer screenings, yet data on this are limited. We sought to compare observed and expected cancer incidence rates for screenable cancers, quantifying potential missed diagnoses. STUDY DESIGN Lung, female breast, and colorectal cancer patients from 2010 to 2020 in the National Cancer Database were standardized to calculate annual incidence rates per 100,000. A linear regression model of 2010 through 2019 incidence rates (pre-COVID) was used to calculate predicted 2020 incidence compared with observed incidence in 2020 (COVID) with subanalyses for age, sex, race, ethnicity, and geographic region. RESULTS In total, 1,707,395 lung, 2,200,505 breast, and 1,066,138 colorectal cancer patients were analyzed. After standardizing, the observed 2020 incidence was 66.888, 152.059, and 36.522 per 100,000 compared with the predicted 2020 incidence of 81.650, 178.124, and 44.837 per 100,000, resulting in an observed incidence decrease of -18.1%, -14.6%, and -18.6% for lung, breast, and colorectal cancer, respectively. The difference was amplified on subanalysis for lung (female, 65 or more years old, non-White, Hispanic, Northeastern and Western region), breast (65 or more years old, non-Black, Hispanic, Northeastern and Western region), and colorectal (male, less than 65 years old, non-White, Hispanic, and Western region) cancer patients. CONCLUSIONS The reported incidence of screenable cancers significantly decreased during the COVID-19 pandemic (2020), suggesting that many patients currently harbor undiagnosed cancers. In addition to the human toll, this will further burden the healthcare system and increase future healthcare costs. It is imperative that providers empower patients to schedule cancer screenings to flatten this pending oncologic wave.
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Affiliation(s)
- Kelsey S Romatoski
- From the Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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15
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Culbert AA, Ren BO, Maheshwer B, Curtis A, Ajayakumar J, Gilmore A, Hardesty C, Mistovich RJ, Son-Hing J, Liu RW, Glotzbecker MP. Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability. J Pediatr Orthop 2023; 43:529-535. [PMID: 37442779 PMCID: PMC10627400 DOI: 10.1097/bpo.0000000000002469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution. METHODS We performed a retrospective cohort study of 6318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, address, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non-fracture-related trauma, sports, elective, and other categories. Geospatial analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed and compared with the Centers for Disease Control (CDC) social vulnerability index (SVI). RESULTS The total number of pediatric orthopedic visits decreased by 22.2% during the pandemic ( P <0.001) and remained 11.6% lower post-vaccine availability compared with prepandemic numbers ( P <0.001). There was no significant difference in age ( P =0.097) or sex ( P =0.248) of the patients across all 3 timepoints; however, patients seen during the pandemic were more often White race (67.7% vs. 59.3%, P <0.001). Post-vaccine availability, trauma visits increased by 18.2% ( P <0.001) and total fractures remained 13.4% lower than prepandemic volume ( P <0.001). Sports volume decreased during the pandemic but returned to prepandemic volume in the post-vaccine availability period ( P =0.298). Elective visits did not recover to prepandemic volume and remained 13.0% lower compared with baseline ( P <0.001). Geospatial analysis of patient distribution illustrated neighborhood trends in access to care during the COVID-19 pandemic, with fewer patients from high SVI and low socioeconomic status neighborhoods seeking fracture care during the pandemic than prepandemic. Post-vaccine availability, fracture population distribution resembled prepandemic levels, suggesting a return to baseline health care utilization. CONCLUSION Pediatric orthopedic surgery visit volume broadly decreased during the COVID-19 pandemic and did not return to prepandemic levels. All categories increased in the post-vaccine availability time point except elective visits. Geospatial analysis revealed that neighborhoods with a high social vulnerability index (SVI) were associated with decreased fracture visits during the pandemic, whereas low SVI neighborhoods did not experience as much of a decline. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population. LEVEL OF EVIDENCE Retrospective Study, Level III.
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Affiliation(s)
- August A. Culbert
- Cleveland Clinic Lerner College of Medicine
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Bryan O. Ren
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI
| | - Bhargavi Maheshwer
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Andrew Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University
| | | | - Allison Gilmore
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Christina Hardesty
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - R. Justin Mistovich
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Jochen Son-Hing
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Raymond W. Liu
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Michael P. Glotzbecker
- Division of Pediatric Orthopedic Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH
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16
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Bentley H, Raveinthiranathan N, Mar C, Tang T, Regier DA, Chi K, Simkin J, Kellow Z, Yong-Hing CJ, Woods RR. Evaluation of the Association Between Sociodemographic Status and Breast Screening Volumes During the COVID-19 Pandemic in a Provincial, Population-Based Organized Breast Screening Program. Can Assoc Radiol J 2023:8465371231192277. [PMID: 37619596 DOI: 10.1177/08465371231192277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES We sought to evaluate the association between patient sociodemographic status and breast screening volumes (BSVs) during the COVID-19 pandemic in a large, population-based breast screening program that serves a provincial population of over 5 million. METHODS All patients who completed breast screening between April 1st, 2017 and March 31st, 2021 were eligible to participate. An average of 3 annual periods between April 1st, 2017 and March 31st, 2020 were defined as the pre-COVID period while the period between April 1st, 2020 and March 31st, 2021 was defined as the COVID-impacted period. The Postal CodeOM Conversion File Plus was applied to map patient residential postal codes to 2016 census standard geographical areas, which provided information on community size, income quintile and dissemination areas. Dissemination areas were subsequently linked to the Canadian Index of Multiple Deprivation (CIMD). RESULTS Overall BSV was reduced by 23.0% during the COVID-impacted period as compared to the pre-COVID period. Percent reductions in BSVs were greatest among younger patients aged 40 to 49 years (31.3%) and patients residing in communities with a population of less than 10,000 (27.0%). Percent reduction in BSV was greatest among patients in the lowest income quintile (28.1%). Percent reductions in BSVs were greatest for patients in the most deprived quintiles across all 4 dimensions of the CIMD. CONCLUSION Disproportionate reductions in BSVs were observed during the COVID-19 pandemic among younger patients, patients residing in rural communities, patients in lower income quintiles, and patients in the most deprived quintiles across all 4 dimensions of the CIMD.
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Affiliation(s)
- Helena Bentley
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Colin Mar
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Imaging, BC Cancer, Vancouver, BC, Canada
| | - Terry Tang
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Dean A Regier
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Kim Chi
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | | | - Zina Kellow
- Department of Radiology, Dalhousie University, Halifax, NS, Canada
| | - Charlotte J Yong-Hing
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Imaging, BC Cancer, Vancouver, BC, Canada
| | - Ryan R Woods
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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17
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Blavin FE, Smith LB, Dubay L, Basurto L. Assessing patterns in cancer screening use by race and ethnicity during the coronavirus pandemic using electronic health record data. Cancer Med 2023; 12:16548-16557. [PMID: 37347148 PMCID: PMC10469733 DOI: 10.1002/cam4.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Efforts to prevent the spread of the coronavirus led to dramatic reductions in nonemergency medical care services during the first several months of the COVID-19 pandemic. Delayed or missed screenings can lead to more advanced stage cancer diagnoses with potentially worse health outcomes and exacerbate preexisting racial and ethnic disparities. The objective of this analysis was to examine how the pandemic affected rates of breast and colorectal cancer screenings by race and ethnicity. METHODS We analyzed panels of providers that placed orders in 2019-2020 for mammogram and colonoscopy cancer screenings using electronic health record (EHR) data. We used a difference-in-differences design to examine the extent to which changes in provider-level mammogram and colonoscopy orders declined over the first year of the pandemic and whether these changes differed across race and ethnicity groups. RESULTS We found considerable declines in both types of screenings from March through May 2020, relative to the same months in 2019, for all racial and ethnic groups. Some rebound in screenings occurred in June through December 2020, particularly among White and Black patients; however, use among other groups was still lower than expected. CONCLUSIONS This research suggests that many patients experienced missed or delayed screenings during the first few months of the pandemic, which could lead to detrimental health outcomes. Our findings also underscore the importance of having high-quality data on race and ethnicity to document and understand racial and ethnic disparities in access to care.
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Affiliation(s)
- Fredric E. Blavin
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Lisa Dubay
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | - Luis Basurto
- Duke University, Sanford School of Public PolicyDurhamNorth CarolinaUSA
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18
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Myers C, Bennett K, Cahir C. Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes. Int J Qual Health Care 2023; 35:mzad048. [PMID: 37497806 PMCID: PMC10373113 DOI: 10.1093/intqhc/mzad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
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19
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Mani SS, Schut RA. The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health. Soc Sci Med 2023; 328:116003. [PMID: 37301108 PMCID: PMC10238126 DOI: 10.1016/j.socscimed.2023.116003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.
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Affiliation(s)
- Sneha Sarah Mani
- Graduate Group in Demography, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Rebecca Anna Schut
- Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, USA.
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20
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Chesebro AL, Amornsiripanitch N, Lan Z, Bay CP, Chikarmane SA. Experience of a single healthcare system with screening mammography before and after COVID-19 shutdown. Clin Imaging 2023; 101:97-104. [PMID: 37327551 PMCID: PMC10249341 DOI: 10.1016/j.clinimag.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To evaluate COVID-19's longitudinal impact on screening mammography volume trends. METHODS HIPAA-compliant, IRB-approved, single institution, retrospective study of screening mammogram volumes before (10/21/2016-3/16/2020) and greater than two years after (6/17/2020-11/30/2022) a state-mandated COVID-19 shutdown (3/17/2020-6/16/2020) were reviewed. A segmented quasi-poisson linear regression model adjusting for seasonality and network and regional population growth compared volume trends before and after the shutdown of each variable: age, race, language, financial source, risk factor for severe COVID-19, and examination location. RESULTS Adjusted model demonstrated an overall increase of 65 screening mammograms per month before versus a persistent decrease of 5 mammograms per month for >2 years after the shutdown (p < 0.0001). In subgroup analysis, downward volume trends were noted in all age groups <70 years (age < 50: +9/month before vs. -7/month after shutdown; age 50-60: +17 vs. -7; and age 60-70: +21 vs. -2; all p < 0.001), those identifying as White (+55 vs. -8, p < 0.0001) and Black (+4 vs. +1, p = 0.009), all financial sources (Medicare: +22 vs. -3, p < 0.0001; Medicaid: +5 vs. +2, p = 0.006; private insurance/self-pay: +38 vs. -4, p < 0.0001), women with at least one risk factor for severe COVID-19 (+30 vs. -48, p < 0.0001), and screening mammograms performed at a hospital-based location (+48 vs. -14, p = 0.0001). CONCLUSION The screening mammogram volume trend more than two years after the COVID-19 shutdown has continued to decline for most patient populations. Findings highlight the need to identify additional areas for education and outreach.
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Affiliation(s)
- Allyson L Chesebro
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Nita Amornsiripanitch
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Zhou Lan
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Camden P Bay
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Takeda Pharmaceuticals, USA, Inc., 650 Kendall St., Cambridge, MA 02142, United States of America
| | - Sona A Chikarmane
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
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21
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Qiao S, Wilcox S, Olatosi B, Li X. COVID-19 challenges, responses, and resilience among rural Black women: a study protocol. Front Public Health 2023; 11:1156717. [PMID: 37333566 PMCID: PMC10275362 DOI: 10.3389/fpubh.2023.1156717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Prevention Research Center, University of South Carolina, Columbia, SC, United States
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Department of Health System Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
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22
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Bharwani A, Li D, Vermund SH. A Review of the Effect of COVID-19-Related Lockdowns on Global Cancer Screening. Cureus 2023; 15:e40268. [PMID: 37448422 PMCID: PMC10336183 DOI: 10.7759/cureus.40268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
COVID-19 lockdowns have led to significant disruptions in preventative health services worldwide. This review aims to assess the impact of COVID-19 lockdowns on worldwide preventive cancer screening participation. Major medical databases were searched using the keywords 'lockdown,' 'cancer,' and 'screening or diagnosis,' and relevant articles were evaluated against inclusion and exclusion criteria. The final review consisted of 38 studies. The impact of COVID-19 on screening uptake was categorized based on cancer type. All types of screening had decreased participation during or around the lockdown period. Racial and socioeconomic disparities, provider-related barriers, and patient attitudes about service disruptions during the pandemic were also highlighted in this review. Future research should focus on data from low- and middle-income countries to obtain a more comprehensive picture of the problem. Policy interventions that adopt self-screening or different screening intervals can also be considered to reduce impacts in future crises. Insights from existing studies and future research will allow for more proactive measures to manage future disruptions.
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Affiliation(s)
| | - Dan Li
- Public Health, Yale University, New Haven, USA
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23
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D'Amico R, Schnell PM, Foraker R, Olayiwola JN, Jonas DE, Brill SB. The Evolution of Primary Care Telehealth Disparities During COVID-19: Retrospective Cohort Study. J Med Internet Res 2023; 25:e43965. [PMID: 37146176 PMCID: PMC10233430 DOI: 10.2196/43965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Telehealth has become widely used as a novel way to provide outpatient care during the COVID-19 pandemic, but data about telehealth use in primary care remain limited. Studies in other specialties raise concerns that telehealth may be widening existing health care disparities, requiring further scrutiny of trends in telehealth use. OBJECTIVE Our study aims to further characterize sociodemographic differences in primary care via telehealth compared to in-person office visits before and during the COVID-19 pandemic and determine if these disparities changed throughout 2020. METHODS We conducted a retrospective cohort study in a large US academic center with 46 primary care practices from April-December 2019 to April-December 2020. Data were subdivided into calendar quarters and compared to determine evolving disparities throughout the year. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios (ORs) with 95% CIs. We used sex, race, and ethnicity of the patient attending each encounter as fixed effects. We analyzed socioeconomic status of patients in the institution's primary county based on the patient's residence zip code. RESULTS A total of 81,822 encounters in the pre-COVID-19 time frame and 47,994 encounters in the intra-COVID-19 time frame were analyzed; in the intra-COVID-19 time frame, a total of 5322 (11.1%) of encounters were telehealth encounters. Patients living in zip code areas with high utilization rate of supplemental nutrition assistance were less likely to use primary care in the intra-COVID-19 time frame (OR 0.94, 95% CI 0.90-0.98; P=.006). Encounters with the following patients were less likely to be via telehealth compared to in-person office visits: patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients insured by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip code areas with high utilization rate of supplemental nutrition assistance (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year. Although there was no statistically significant difference in telehealth use for patients insured by Medicaid throughout the whole year, subanalysis of quarter 4 found encounters with patients insured by Medicaid were less likely to be via telehealth (OR 0.73, 95% CI 0.55-0.97; P=.03). CONCLUSIONS Telehealth was not used equally by all patients within primary care throughout the first year of the COVID-19 pandemic, specifically by patients who self-identified as Asian and Nepali, insured by Medicare, and living in zip code areas with low socioeconomic status. As the COVID-19 pandemic and telehealth infrastructure change, it is critical we continue to reassess the use of telehealth. Institutions should continue to monitor disparities in telehealth access and advocate for policy changes that may improve equity.
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Affiliation(s)
- Rachel D'Amico
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Randi Foraker
- Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO, United States
| | | | - Daniel E Jonas
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Seuli Bose Brill
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
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24
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An TJ, Kim N, King AH, Panzarini B, Little BP, Goiffon RJ, Meyersohn N, Garrana S, Stowell J, Saini S, Ghoshhajra BB, Hedgire S, Succi MD. Trends in coronary calcium score and coronary CT angiography imaging volume during the COVID-19 pandemic. Curr Probl Diagn Radiol 2023; 52:175-179. [PMID: 36473800 PMCID: PMC9673185 DOI: 10.1067/j.cpradiol.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The COVID-19 pandemic disrupted the delivery of preventative care and management of acute diseases. This study assesses the effect of the COVID-19 pandemic on coronary calcium score and coronary CT angiography imaging volume. MATERIALS AND METHODS A single institution retrospective review of consecutive patients presenting for coronary calcium score or coronary CT angiography examinations between January 1, 2020 to January 4, 2022 was performed. The weekly volume of calcium score and coronary CT angiogram exams were compared. RESULTS In total, 1,817 coronary calcium score CT and 5,895 coronary CT angiogram examinations were performed. The average weekly volume of coronary CTA and coronary calcium score CT exams decreased by up to 83% and 100%, respectively, during the COVID-19 peak period compared to baseline (P < 0.0001). The post-COVID recovery through 2020 saw weekly coronary CTA volumes rebound to 86% of baseline (P = 0.024), while coronary calcium score CT volumes remained muted at only a 53% recovery (P < 0.001). In 2021, coronary CTA imaging eclipsed pre-COVID rates (P = 0.012), however coronary calcium score CT volume only reached 67% of baseline (P < 0.001). CONCLUSIONS A significant decrease in both coronary CTA and coronary calcium score CT volume occurred during the peak-COVID-19 period. In 2020 and 2021, coronary CTA imaging eventually superseded baseline rates, while coronary calcium score CT volumes only reached two thirds of baseline. These findings highlight the importance of resumption of screening exams and should prompt clinicians to be aware of potential undertreatment of patients with coronary artery disease.
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Affiliation(s)
- Thomas J An
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA
| | - Nicole Kim
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA
| | - Alexander H King
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA
| | - Bruno Panzarini
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA
| | - Brent P Little
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Reece J Goiffon
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Nandini Meyersohn
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Sherief Garrana
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Justin Stowell
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Sanjay Saini
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA
| | - Brian B Ghoshhajra
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Sandeep Hedgire
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Marc D Succi
- Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Boston, MA; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA.
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25
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Lomahan S, Rauscher GH, Murphy AM. The role of facility and patient mix factors on recovery of screening and diagnostic mammography volumes following the initial COVID-19 pandemic wave. Cancer Med 2023; 12:10877-10888. [PMID: 36924321 PMCID: PMC10225188 DOI: 10.1002/cam4.5793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. METHOD Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. RESULTS Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. CONCLUSION Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.
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Affiliation(s)
| | - Garth H. Rauscher
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
- University of Illinois Cancer CenterChicagoIllinoisUSA
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26
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Maculaitis MC, Liu X, Berk A, Massa A, Weiss MC, Kurosky SK, Li B, McRoy L. Psychosocial Wellbeing among Patients with Breast Cancer during COVID-19. Curr Oncol 2023; 30:3886-3900. [PMID: 37185407 PMCID: PMC10136618 DOI: 10.3390/curroncol30040294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
The impact of coronavirus disease 2019 (COVID-19) on the wellbeing of breast cancer (BC) patients is not well understood. This study described psychosocial problems among these patients in the United States (US) during the COVID-19 pandemic. Data were collected from BC patients via an online self-report survey between 30 March-6 July 2021 to assess the prevalence of COVID-19 diagnosis history and potential depression, health-related quality of life, COVID-related stress, and financial toxicity. Patients with early-stage (eBC) and metastatic (mBC) disease were compared. Of 669 patients included in the analysis, the prevalence of COVID-19 diagnosis history (10.9% versus 7.7%) and potential depression (33.7% versus 28.3%) were higher in mBC than eBC patients. Patients with eBC (versus mBC) had higher scores on nearly all Functional Assessment of Cancer Therapy-Breast scales (all, p < 0.001). For the Psychological Impact of Cancer subscales measuring negative coping strategies, the emotional distress score was the highest (9.1 ± 1.8) in the overall sample. Comprehensive Score for Financial Toxicity scores were higher in eBC than in mBC patients (24.2 ± 11.3 vs. 21.3 ± 10.2, p < 0.001). Overall, the COVID-19-related stress score was highest for danger/contamination fears (8.2 ± 5.6). In conclusion, impairments to psychosocial wellbeing among patients during the pandemic were observed, particularly financial toxicity and poor mental health and emotional functioning, with greater problems among mBC patients.
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Affiliation(s)
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA 19003, USA
- Lankenau Medical Center, Wynnewood, PA 19096, USA
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27
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Cheng D, Ghoshal S, Zattra O, Flash M, Lang M, Liu R, Lev MH, Hirsch JA, Saini S, Gee MS, Succi MD. Trends in oncological imaging during the COVID-19 pandemic through the vaccination era. Cancer Med 2023; 12:9902-9911. [PMID: 36775966 PMCID: PMC10166903 DOI: 10.1002/cam4.5678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/22/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND This study examines the impact that the COVID-19 pandemic has had on computed tomography (CT)-based oncologic imaging utilization. METHODS We retrospectively analyzed cancer-related CT scans during four time periods: pre-COVID (1/5/20-3/14/20), COVID peak (3/15/20-5/2/20), post-COVID peak (5/3/20-12/19/20), and vaccination period (12/20/20-10/30/21). We analyzed CTs by imaging indication, setting, and hospital type. Using percentage decrease computation and Student's t-test, we calculated the change in mean number of weekly cancer-related CTs for all periods compared to the baseline pre-COVID period. This study was performed at a single academic medical center and three affiliated hospitals. RESULTS During the COVID peak, mean CTs decreased (-43.0%, p < 0.001), with CTs for (1) cancer screening, (2) initial workup, (3) cancer follow-up, and (4) scheduled surveillance of previously treated cancer dropping by 81.8%, 56.3%, 31.7%, and 45.8%, respectively (p < 0.001). During the post-COVID peak period, cancer screenings and initial workup CTs did not return to prepandemic imaging volumes (-11.4%, p = 0.028; -20.9%, p = 0.024). The ED saw increases in weekly CTs compared to prepandemic levels (+31.9%, p = 0.008), driven by increases in cancer follow-up CTs (+56.3%, p < 0.001). In the vaccination period, cancer screening CTs did not recover to baseline (-13.5%, p = 0.002) and initial cancer workup CTs doubled (+100.0%, p < 0.001). The ED experienced increased cancer-related CTs (+75.9%, p < 0.001), driven by cancer follow-up CTs (+143.2%, p < 0.001) and initial workups (+46.9%, p = 0.007). CONCLUSIONS AND RELEVANCE The pandemic continues to impact cancer care. We observed significant declines in cancer screening CTs through the end of 2021. Concurrently, we observed a 2× increase in initial cancer workup CTs and a 2.4× increase in cancer follow-up CTs in the ED during the vaccination period, suggesting a boom of new cancers and more cancer examinations associated with emergency level acute care.
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Affiliation(s)
- Debby Cheng
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Soham Ghoshal
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ottavia Zattra
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moses Flash
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Min Lang
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raymond Liu
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael H Lev
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua A Hirsch
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sanjay Saini
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Gee
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc D Succi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts, USA
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28
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Grumbach K, Gagliardi K, Coleman Hernandez S, Intinarelli G. Messaging About COVID-19 Safety Measures Is Counterproductive in Cancer Screening Outreach: Results of a Pragmatic Randomized Trial. Jt Comm J Qual Patient Saf 2023; 49:120-122. [PMID: 36443165 PMCID: PMC9635946 DOI: 10.1016/j.jcjq.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
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Lopez Bray C, Taylor R, Tamez N, Durkalski W, Litaker JR. Hepatitis C Virus Screening among Baby Boomers: The Positive Benefits of Health Education and Outreach during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11030302. [PMID: 36766877 PMCID: PMC9914406 DOI: 10.3390/healthcare11030302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
In 2019, 2020, and 2021, Sendero Health Plans, an ACA health insurance company, implemented Hepatitis C Virus (HCV) health education and outreach screening campaigns. Chi-square goodness-of-fit and tests of independence were performed to assess and compare the uptake of HCV screening among baby boomers in 2019, 2020, and 2021. In 2019, 2020, and 2021, 17.9% (308/1,718), 10.9% (93/852), and 8.5% (37/435) of eligible members were screened, respectively. Individuals were more likely to be screened for HCV in 2019 than in 2020 and 2021 (p < 0.0001). In 2019, 2020, and 2021, 39.9%, 26.9%, and 48.6% of annual screenings occurred during the health campaign months, respectively. Annual HCV screening rates were lower during the COVID-19 pandemic period than in the pre-pandemic cohort. However, screening rates during the months of outreach and education contributed to nearly 50% of annual screenings in the pandemic year 2021, thus representing a positive impact on preventive screening uptake despite the pandemic. Missed screening opportunities affect HCV transmission, diagnosis, and treatment. Yet, health education and outreach continue to work, even during a pandemic.
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Affiliation(s)
- Carlos Lopez Bray
- Office of Population Health, Sendero Health Plans, Inc., Austin, TX 78741, USA
| | - Richard Taylor
- Undergraduate Public Health Program, The University of Texas at Austin, Austin, TX 78712, USA
| | - Naomi Tamez
- Office of Population Health, Sendero Health Plans, Inc., Austin, TX 78741, USA
| | - Wesley Durkalski
- Former Chief Executive Officer, Sendero Health Plans, Inc., Austin, TX 78741, USA
| | - John R. Litaker
- Office of Population Health and Science, The Litaker Group, LLC, Austin, TX 78716, USA
- Correspondence:
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30
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Impact of COVID-19 pandemic on medication use in the older Italian population. Aging Clin Exp Res 2023; 35:443-453. [PMID: 36469252 PMCID: PMC9734516 DOI: 10.1007/s40520-022-02303-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aims to analyse the impact of the pandemic on the amount of use and new medication dispensation for chronic diseases in the Italian population aged 65 years and older (almost 14 million inhabitants). METHODS The "Pharmaceutical Prescriptions database", which gathers data on medications, reimbursed by the National Health Service and dispensed by community pharmacies, was employed. Data were analysed as amount of use (defined daily dose-DDD per 1000 inhabitants); variation in DDD between 2020 and 2019 was calculated for the 30 categories with major consumption in 2020. Trends in prevalence and incidence of dispensations between 2020 and 2019 were calculated for four categories: antidiabetics, antihypertensives, antidepressants and drugs for respiratory diseases. RESULTS All medications showed a negative variation in DDD/1000 inhabitants between 2020 and 2019 except for anticoagulants (+ 5%). The percentage variation ranged from - 27.7% for antibiotics to - 6.4% for antipsychotics in 85 + year-old persons, but increased for most classes in the youngest (65-69 years). On the other hand, a decrease of the dispensation incidence of antidiabetics, antihypertensives, antidepressants and drugs for pulmonary disease was high, especially in the two extreme age groups, the youngest and the oldest one. CONCLUSIONS AND RELEVANCE Great variation in medication use between 2020 and 2019 was observed probably reflecting the low rate of infectious diseases due to the widespread use of protective devices and self-isolation, reduced healthcare access because of the lockdowns and the fear of going to hospital, and the reduction of screening and diagnostics due to health-care system overload.
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Angelini M, Teglia F, Astolfi L, Casolari G, Boffetta P. Decrease of cancer diagnosis during COVID-19 pandemic: a systematic review and meta-analysis. Eur J Epidemiol 2023; 38:31-38. [PMID: 36593334 PMCID: PMC9807424 DOI: 10.1007/s10654-022-00946-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023]
Abstract
Many health services, including cancer care, have been affected by the COVID-19 epidemic. This study aimed at providing a systematic review of the impact of the epidemic on cancer diagnostic tests and diagnosis worldwide. In our systematic review and meta-analysis, databases such as Pubmed, Proquest and Scopus were searched comprehensively for articles published between January 1st, 2020 and December 12th, 2021. Observational studies and articles that reported data from single clinics and population registries comparing the number of cancer diagnostic tests and/or diagnosis performed before and during the pandemic, were included. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval and study setting. The review was registered on PROSPERO (ID: CRD42022314314). The review comprised 61 articles, whose results referred to the period January-October 2020. We found an overall decrease of - 37.3% for diagnostic tests and - 27.0% for cancer diagnosis during the pandemic. For both outcomes we identified a U-shaped temporal trend, with an almost complete recovery for the number of cancer diagnosis after May 2020. We also analyzed differences by geographic area and screening setting. We provided a summary estimate of the decrease in cancer diagnosis and diagnostic tests, during the first phase of the COVID-19 pandemic. The delay in cancer diagnosis could lead to an increase in the number of avoidable cancer deaths. Further research is needed to assess the impact of the pandemic measures on cancer treatment and mortality.
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Affiliation(s)
- Marco Angelini
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Federica Teglia
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Laura Astolfi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giulia Casolari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy ,Stony Brook Cancer Center, Stony Brook University, New York, NY USA
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Zangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. A silence full of words: sociocultural beliefs behind the sexual health of Iranian women undergoing breast cancer treatment, a qualitative study. Support Care Cancer 2023; 31:84. [PMID: 36574074 PMCID: PMC9792940 DOI: 10.1007/s00520-022-07502-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/10/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Therapeutic interventions lead to impaired sexual health in women undergoing breast cancer treatment. There are some problem such as vaginal dryness, decreased libido, decreased sexual satisfaction, and decreased frequency of sexual intercourse among breast cancer survivors. This study was conducted to discover the sexual experiences of women undergoing breast cancer treatment. METHODS A total of 39 semi-structured interviews were held with the women undergoing breast cancer treatment, husbands, and health care providers. Recorded interviews were transcribed and analyzed using qualitative content analysis. RESULTS Three categories of cultural and gender taboos, adherence to subjective norms, and hidden values in sexuality were revealed. The cultural and gender taboos category consisted of subcategories of learned sexual shame, fear of judgment, sexual schemas, and gender stereotypes. The adherence to subjective norms category consisted of subcategories of sexual socialization, being labeled as a disabled woman and the priority of being alive to sexuality. The hidden values in sexuality category consist of subcategories of Task-based sexuality, Tamkin, and Sexuality prevents infidelity. CONCLUSIONS Socio-cultural beliefs affect the sexual health of women undergoing breast cancer treatment, so paying attention to this issue can improve the quality of sexual health services.
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Affiliation(s)
- Sanaz Zangeneh
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Savabi-Esfahani
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezar Jerib STR, P. O. Box, Isfahan, 81746-73461 Iran
| | - Fariba Taleghani
- Faculty of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Omid Hospital, Iranian Cancer Control Center (MACSA), Isfahan, Iran
| | - Mehrdad Salehi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Bucher A, Blazek ES, West AB. Feasibility of a Reinforcement Learning-Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study. JMIR Form Res 2022; 6:e42343. [PMID: 36441579 DOI: 10.2196/42343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). OBJECTIVE The aim of this study was to establish the feasibility of a reinforcement learning-enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention's reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. METHODS The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system's existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science-based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. RESULTS In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. CONCLUSIONS The reinforcement learning-enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact.
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COVID-19 related decline in cancer screenings most pronounced for elderly patients and women in Germany: a claims data analysis. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04433-z. [DOI: 10.1007/s00432-022-04433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to analyze the utilization of cancer screenings in Germany before and during the COVID-19 pandemic in 2020. The objective of the analysis was to identify the population at particular risk and to derive recommendations for the future use of resources to prevent long-term deteriorations in health outcomes.
Methods
The analysis was conducted based on claims data of all preventive health services for 15,833,662 patients from the largest statutory health insurance fund in Germany. Utilization of general female cancer screening, general male cancer screening, general health checkup, colorectal cancer screening stool test, colorectal cancer screening consultation, colonoscopy, skin cancer screening, and mammography screening was compared before (2017–2019) and during (2020) the pandemic.
Results
Data of a total of 42,046,078 observed screenings showed that the utilization of the individual screenings developed differently, but that the overall utilization decreased significantly by 21.46% during the COVID-19 pandemic (p < 0.001). At the same time, no catch-up effects were detected for total screenings throughout the entire year 2020. The highest decline in screenings was found for the elderly (p < 0.001) and women (p < 0.001).
Conclusion
Because the elderly are at higher risk for cancer, the omission of early detection might lead to higher treatment costs, reduced quality of life, and higher mortality. In addition, women's medical care in particular has been negatively affected, for example, by the interruption of mammography screenings and the lack of catch-up effects. Therefore, resources must be targeted to reduce burdens on health outcomes and public health in the long term.
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Ryder KM, Ricardo-Dukelow ML, Patel A, Barit C, Watson G. More Than a Health Fair: Preventive Health Care During COVID-19 Vaccine Events. Fed Pract 2022; 39:454-458. [PMID: 36582496 PMCID: PMC9794173 DOI: 10.12788/fp.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background During the initial phase of the COVID-19 pandemic, facilities transformed some medical care to virtual appointments. There was a subsequent decline in chronic disease screening and management, as well as cancer screening rates. Observations COVID-19 vaccine events offered an opportunity to provide face-to-face preventive care to veterans, and mobile vaccine events enabled us to reach rural veterans. In this quality improvement project, we partnered with state and community organizations to reach veterans at large vaccine events, as well as in rural sites and homeless housing. The program resulted in the successful provision of preventive care to 115 veterans at these events, with high follow-up for recommended medical care. In all, 404 clinical reminders were completed and 10 new veterans were enrolled for health care. Important clinical findings included an invasive colorectal cancer, positive HIV point-of-care test, diabetic retinal disease, uncontrolled hypertension, and depression. Conclusions Vaccine events offer a venue for chronic disease screening, referral, and cancer screening.
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Affiliation(s)
- Kathryn M. Ryder
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii
| | | | - Ashni Patel
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii
| | - Chaz Barit
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii
| | - Gloriann Watson
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii
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Carter BJ, Chen TA, Cho D, Connors SK, Siddiqi AD, McNeill LH, Reitzel LR. Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13004. [PMID: 36293643 PMCID: PMC9602462 DOI: 10.3390/ijerph192013004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
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Teng H, Dang W, Curpen B. Impact of COVID-19 and Socioeconomic Factors on Delays in High-Risk MRI Breast Cancer Screening. Tomography 2022; 8:2171-2181. [PMID: 36136878 PMCID: PMC9498669 DOI: 10.3390/tomography8050182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to investigate if there was a delay in high-risk MRI breast cancer screening in our local region, if this delay is ongoing despite COVID-19 vaccinations, and if demographic and socioeconomic factors are associated with these delays. Six-hundred and sixty-five high-risk breast patients from 23 January 2018–30 September 2021 were included. Delays were determined by comparing the time in between each patients’ MRI screening exams prior to the COVID-19 pandemic to the time in between MRI screening exams during the height of the COVID-19 pandemic as well as the time in between exams when our patients started receiving vaccinations. Delays were analyzed via logistical regression with demographic and socioeconomic factors to determine if there was an association between these factors and delays. Significant time delays in between MRI screening exams were found between the pre-COVID timeframe compared to during the height of COVID. Significant time delays also persisted during the timeframe after patients started getting vaccinations. There were no associations with delays and socioeconomic or demographic factors. Significant time delays were found in between MRI high-risk breast cancer screening examinations due to the COVID-19 pandemic. These delays were not exacerbated by demographic or socioeconomic factors.
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Affiliation(s)
- Helena Teng
- Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
- Correspondence:
| | - Wilfred Dang
- Department of Medical Imaging, Sunnybrook Health Sciences, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
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Amram O, Amiri S, Robison J, Pflugeisen C, Monsivais P. COVID-19 and inequities in colorectal and cervical cancer screening and diagnosis in Washington State. Cancer Med 2022; 11:2990-2998. [PMID: 35304835 PMCID: PMC9110900 DOI: 10.1002/cam4.4655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Studies have shown that cancer screenings dropped dramatically following the onset of the coronavirus diseases 2019 (COVID-19) pandemic. In this study, we examined differences in rates of cervical and colorectal cancer (CRC) screening and diagnosis indicators before and during the first year of the COVID-19 pandemic. METHODOLOGY We used retrospective data from a large healthcare system in Washington State. Targeted screening data included completed cancer screenings for both CRC (colonoscopy) and cervical cancer (Papanicolaou test (Pap test)). We analyzed and compared the rate of uptake of colorectal (colonoscopies) and cervical cancer (Pap) screenings done pre-COVID-19 (April 1, 2019-March 31, 2020) and during the pandemic (April 1, 2020-March 31, 2021). RESULTS A total of 26,081 (12.7%) patients underwent colonoscopies in the pre-COVID-19 period, compared to only 15,708 (7.4%) patients during the pandemic, showing a 39.8% decrease. A total of 238 patients were referred to medical oncology for CRC compared to only 155 patients during the first year of the pandemic, a reduction of 34%. In the pre-COVID-19 period, 22,395 (10.7%) women were administered PAP tests compared to 20,455 (9.6%) women during the pandemic, for a 7.4% reduction. period 1780 women were referred to colposcopy, compared to only 1680 patients during the pandemic, for a 4.3% reduction. CONCLUSION Interruption in screening and subsequent delay in diagnosis during the pandemic will likely lead to later-stage diagnoses for both CRC and cervical cancer, which is known to result in decreased survival. IMPACT The results emphasize the need to prioritize cancer screening, particularly for those at higher risk.
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Affiliation(s)
- Ofer Amram
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
- Paul G. Allen School for Global Animal HealthWashington State UniversityPullmanWashingtonUSA
| | - Solmaz Amiri
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
| | - Jeanne Robison
- MultiCare Institute for Research & InnovationTacomaWashingtonUSA
- MultiCare Deaconess Cancer & Blood Specialty Centers Spokane WashingtonSpokaneWashingtonUSA
| | | | - Pablo Monsivais
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
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Luu T. Reduced Cancer Screening Due to Lockdowns of the COVID-19 Pandemic: Reviewing Impacts and Ways to Counteract the Impacts. Front Oncol 2022; 12:955377. [PMID: 35965514 PMCID: PMC9372444 DOI: 10.3389/fonc.2022.955377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has created disruptions in health services in general and cancer screening and diagnostic services in particular, leading to diminished cancer screening participation rates. This paper aims to seek insights into impacts that the pandemic has had on cancer screening, impacts that reduced cancer screening may have in the long run, and how to address such impacts. The paper demonstrates that reduced cancer screening in the pandemic is likely to result in enhanced demands for cancer screening in the new normal, enhanced demands for resources to address such demands, and poor prognosis due to stage migration of cancer diseases. Some measures are recommended for counteracting these impacts.
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Baaske A, Brotto LA, Galea LAM, Albert AY, Smith L, Kaida A, Booth A, Gordon S, Sadarangani M, Racey CS, Gottschlich A, Ogilvie GS. Barriers to Accessing Contraception and Cervical and Breast Cancer Screening During the COVID-19 Pandemic. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1076-1083. [PMID: 35738558 PMCID: PMC9212845 DOI: 10.1016/j.jogc.2022.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022]
Abstract
Objective This study sought to examine how access to contraception and cervical and breast cancer screening in British Columbia, Canada, has been affected by the COVID-19 pandemic. Methods From August 2020 to March 2021, 3691 female residents of British Columbia (age 25–69 y) participated in this study. We used generalized estimating equations to analyze the proportion of females accessing contraception and the proportion having difficulty accessing contraception across the different phases of pandemic control measures, and logistic regression to analyze attendance at cervical and breast cancer screening. We added sociodemographic and biological variables individually into the models. Self-reported barriers to accessing contraception and attending screening were summarized. Results During phases with the highest pandemic controls, self-reported access to contraception was lower (OR 0.94; 95% CI 0.90–0.98; P = 0.005) and difficulty with access was higher (OR 2.74; 95% CI 1.54–4.88; P = 0.001). A higher proportion of adults aged 25–34 years reported difficulty accessing contraception than those aged 35–39 years (P < 0.0001), and participants identifying as Indigenous had higher odds of access difficulties (OR 5.56; 95% CI 2.44–12.50; P < 0.001). Of those who required screening during the COVID-19 pandemic, 62% and 54.5% did not attend at least one of their cervical or breast screening appointments, respectively. Those with a history of breast cancer had significantly higher odds of self-reporting having attended their mammogram appointment compared with those without a history of breast cancer (OR 5.62; 95% CI 2.69–13.72; P < 0.001). The most common barriers to screening were difficulty getting an appointment and appointments being considered non-urgent. Conclusions The COVID-19 pandemic has uniquely affected access to contraception and cancer screening participation for various subgroups. Self-reported data present potential avenues for mitigating barriers.
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Affiliation(s)
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
| | - Liisa A M Galea
- Women's Health Research Institute, Vancouver, BC; Department of Psychology, University of British Columbia, Vancouver, BC
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, BC; Cancer Control Research, BC, Cancer, Vancouver, BC
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | | | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC
| | - C Sarai Racey
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Anna Gottschlich
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
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Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Bosch G, Posso M, Louro J, Roman M, Porta M, Castells X, Macià F. Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study. eLife 2022; 11:e77434. [PMID: 35686727 PMCID: PMC9212994 DOI: 10.7554/elife.77434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. Methods We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. Results During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59-0.67] and aOR = 0.95 [95% CI = 0.86-1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01-1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56-0.99] and aOR = 0.80 [95% CI = 0.68-0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66-1.28] and incident aOR = 0.72 [95% CI = 0.59-0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76-2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69-1.18]), or cancer stages. Conclusions The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. Funding This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPFBarcelonaSpain
| | - Margarita Posso
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS)BarcelonaSpain
| | - Javier Louro
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS)BarcelonaSpain
| | - Marta Roman
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS)BarcelonaSpain
| | - Miquel Porta
- Universitat Autònoma de BarcelonaBarcelonaSpain
- Hospital del Mar Institute of Medical Research (IMIM PSMar)BarcelonaSpain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Xavier Castells
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS)BarcelonaSpain
- Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Francesc Macià
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS)BarcelonaSpain
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Carnahan MB, Sharpe RE, Oluyemi E, Parra L, Hippe DS, Lorans R, Perry H, Moey THL, Bagadiya N, Lee JM. Women's Experience With Screening Mammography During the COVID-19 Pandemic: A Multi-Institutional Prospective Survey Study. JOURNAL OF BREAST IMAGING 2022; 4:253-262. [PMID: 38416975 PMCID: PMC9129165 DOI: 10.1093/jbi/wbac022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluate women's anxiety and experience undergoing screening mammography during the COVID-19 pandemic. METHODS An IRB-approved anonymous survey was administered to women receiving screening mammography across six sites in the U.S. and Singapore from October 7, 2020, to March 11, 2021. Using a 1-5 Likert scale, women rated their pre- and post-visit anxiety regarding having their mammogram during the COVID-19 pandemic, importance of observed COVID-19 precautions, and personal risk factors for breast cancer and severe COVID-19 illness. Post-visit change in anxiety was evaluated. Multivariable logistic regression was used to test associations of pre-visit anxiety with breast cancer and COVID-19 risk factors. RESULTS In total, 1086 women completed the survey. Of these, 59% (630/1061) had >1 breast cancer risk factor; 27% (282/1060) had >1 COVID-19 risk factors. Forty-two percent (445/1065) experienced pre-visit anxiety. Pre-visit anxiety was independently associated with risk factors for severe COVID-19 (OR for >2 vs 0 risk factors: 2.04, 95% confidence interval [CI]: 1.11-3.76) and breast cancer (OR for >2 vs 0 risk factors: 1.71, 95% CI: 1.17-2.50), after adjusting for age and site. Twenty-six percent (272/1065) of women reported post-visit anxiety, an absolute 16% decrease from pre-visit anxiety (95% CI: 14%-19%, P < 0.001). Provider masking (941/1075, 88%) and physical distancing (861/1085, 79%) were rated as the most important precautions. CONCLUSION Pre-visit anxiety was associated with COVID-19 or breast cancer risk factors and declined significantly after screening mammography. Provider masking and physical distancing were rated the most important precautions implemented by imaging clinics.
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Affiliation(s)
| | | | - Eniola Oluyemi
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Laura Parra
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Daniel S Hippe
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Roxanne Lorans
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Hannah Perry
- University of Vermont, Department of Radiology, Burlington, VT, USA
| | - Tammy Hui Lin Moey
- Singapore General Hospital, Department of Diagnostic Radiology, Singapore, Singapore
| | - Neeti Bagadiya
- Emory University, Department of Radiology, Atlanta, GA USA
| | - Janie M Lee
- University of Washington, Department of Radiology, Seattle, WA, USA
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Price ST, Mainous AG, Rooks BJ. Survey of cancer screening practices and telehealth services among primary care physicians during the COVID-19 pandemic. Prev Med Rep 2022; 27:101769. [PMID: 35313453 PMCID: PMC8928753 DOI: 10.1016/j.pmedr.2022.101769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic resulted in rapid implementation of telehealth within primary care impacting cancer screening. We sought to assess the impact of increased telehealth use on physician recommendation for cancer screenings during the COVID-19 pandemic in North America. Primary care physicians (n = 757) were surveyed in Fall 2020 through the Council of Academic Family Medicine's Educational Research Alliance (CERA) general membership survey. Respondents were asked about cancer screening practices and telehealth services during the COVID-19 pandemic. Chi-squared tests were performed to assess relationships between cancer screening practices and changes in care necessitated by the shift to telehealth services. Associations between participant responses and those reporting a diminished patient-provider relationship were assessed with multivariable logistic regression. A substantial proportion of respondents reported postponing screening for breast (34.5%), colon (32.9%), and cervical cancer (31%), and a majority (51.1%) agreed changes in care seeking will lead to increased incidence of late stage cancer. Physicians reported high use of telehealth during the pandemic, but endorsed limitations in its use to maintain cancer screening practices and the patient-provider relationship. Physicians who reported patients were afraid to come into the office were more likely to report an impaired patient-provider relationship (OR = 2.77, 95% CI: 1.33 - 7.87). Physicians who reported that telehealth maintains their patient-provider relationship were less likely to report an impaired patient-provider relationship (OR = 0.33, 95% CI: 0.17 - 0.67). As telehealth becomes increasingly prominent, evaluation of the impact of telehealth on cancer screening and patient-provider relationships will be increasingly important for primary care.
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Affiliation(s)
- Sarah T. Price
- Department of Family Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 405 MSC 192, Charleston 29425, USA
| | - Arch G. Mainous
- Department of Community Health and Family Medicine, University of Florida, 1329 SW 16 Street 4270, Gainesville 32608, USA
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
| | - Benjamin J. Rooks
- Department of Health Services Research, 1225 Center Drive, University of Florida, Gainesville 32603, USA
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Abstract
Purpose for Review This perspective piece aims to understand the impacts of the COVID-19 pandemic on the field of oncology, exploring the factors provoking a fall in cancer diagnostic rates, interruption of cancer screening programmes, disruption of oncological treatment and adjuvant care, and the necessary adaption oncological practice has undergone (and will be required to undergo) post-pandemic, including the shift to digital consultations. Recent Findings During the COVID-19 pandemic, the field of oncological research has faced significant challenges. Yet, innovation has prevailed with new developments being made across the globe. Looking to the future of oncology, this piece will also suggest potential solutions to overcome the late-stage ramifications of the COVID-19 pandemic. Summary The COVID-19 pandemic has triggered a global health crisis, the ramifications of which have reached every corner of the world and overwhelmed already overburdened healthcare systems. However, we are still yet to see the full domino effect of the pandemic as it continues to reveal and exacerbate pre-existing weaknesses in healthcare systems across the world.
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Affiliation(s)
- Danielle Boniface
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Gonzalo Tapia-Rico
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Icon Cancer Centre Adelaide, Kurralta Park, South Australia, 5037, Australia
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46
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Lowry KP, Bissell MCS, Miglioretti DL, Kerlikowske K, Alsheik N, Macarol T, Bowles EJA, Buist DSM, Tosteson ANA, Henderson L, Herschorn SD, Wernli KJ, Weaver DL, Stout NK, Sprague BL. Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic. Radiology 2022; 303:287-294. [PMID: 34665032 PMCID: PMC8544262 DOI: 10.1148/radiol.2021211808] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. The number of monthly and cumulative biopsies recommended and performed and the number of subsequent cancers diagnosed during the pandemic period (March 2020 to September 2020) were compared with data from the prepandemic period using Wald χ2 tests. Analyses were stratified by mode of detection and race or ethnicity. Results From January 2019 to September 2020, 17 728 biopsies were recommended and performed, with 6009 cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses when compared with the same period in 2019 (1650 recommendations in 2020 vs 2171 recommendations in 2019 [24% fewer], P < .001), predominantly due to fewer screen-detected cancers (722 cancers in 2020 vs 1169 cancers in 2019 [38% fewer], P < .001) versus symptomatic cancers (895 cancers in 2020 vs 965 cancers in 2019 [7% fewer], P = .27). The decrease in cancer diagnoses was largest in Asian (67 diagnoses in 2020 vs 142 diagnoses in 2019 [53% fewer], P = .06) and Hispanic (82 diagnoses in 2020 vs 145 diagnoses in 2019 [43% fewer], P = .13) women, followed by Black women (210 diagnoses in 2020 vs 287 diagnoses in 2019 [27% fewer], P = .21). The decrease was smallest in non-Hispanic White women (1128 diagnoses in 2020 vs 1357 diagnoses in 2019 [17% fewer], P = .09). Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared with the same period in 2019, with Asian and Hispanic women experiencing the largest declines, followed by Black women. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Heller in this issue.
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Affiliation(s)
- Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Michael C. S. Bissell
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Nila Alsheik
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Tere Macarol
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana S. M. Buist
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Louise Henderson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Sally D. Herschorn
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karen J. Wernli
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Donald L. Weaver
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Natasha K. Stout
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
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47
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Fasano GA, Bayard S, Tamimi R, Bea V, Malik M, Davis M, Simmons R, Swistel A, Marti J, Drotman M, Katzen J, Formenti S, Ng J, Astrow A, Taiwo E, Balogun O, Siegel B, Radzio A, Elreda L, Chen Y, Newman L. Impact of the COVID-19 breast cancer screening hiatus on clinical stage and racial disparities in New York City. Am J Surg 2022; 224:1039-1045. [PMID: 35641320 PMCID: PMC9135673 DOI: 10.1016/j.amjsurg.2022.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 12/18/2022]
Abstract
Background The impact of the COVID-19 mammography screening hiatus as well as of post-hiatus efforts promoting restoration of elective healthcare on breast cancer detection patterns and stage distribution is unknown. Methods Newly diagnosed breast cancer patients (2019–2021) at the New York Presbyterian (NYP) Hospital Network were analyzed. Chi-square and student's t-test compared characteristics of patients presenting before and after the screening hiatus. Results A total of 2137 patients were analyzed. Frequency of screen-detected and early-stage breast cancer declined post-hiatus (59.7%), but returned to baseline (69.3%). Frequency of screen-detected breast cancer was lowest for African American (AA) (57.5%) and Medicaid patients pre-hiatus (57.2%), and this disparity was reduced post-hiatus (65.3% for AA and 63.2% for Medicaid). Conclusions The return to baseline levels of screen-detected cancer, particularly among AA and Medicaid patients suggest that large-scale breast health education campaigns may be effective in resuming screening practices and in mitigating disparities.
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Affiliation(s)
- Genevieve A Fasano
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Solange Bayard
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Rulla Tamimi
- New York Presbyterian - Weill Cornell Medicine Department of Population Health Sciences, 402 East 67th Street, LA-219, New York, NY, 10065, USA
| | - Vivian Bea
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Breast Surgery, 506 6th Street, Brooklyn, NY, 11215, USA
| | - Manmeet Malik
- New York Presbyterian - Queens Hospital, Department of Breast Surgery, 56-45 Main Street Queens, NY, 11355, USA
| | - Melissa Davis
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Rache Simmons
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Alexander Swistel
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Jennifer Marti
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Michele Drotman
- Weill Cornell Imaging at New York Presbyterian, 425 East 61st Street, 9th Floor, New York, NY, 10021, USA
| | - Janine Katzen
- Weill Cornell Imaging at New York Presbyterian, 425 East 61st Street, 9th Floor, New York, NY, 10021, USA
| | - Silvia Formenti
- New York Presbyterian-Weill Cornell Medicine, Department of Radiation Oncology, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - John Ng
- New York Presbyterian-Weill Cornell Medicine, Department of Radiation Oncology, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA
| | - Alan Astrow
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Medical Oncology, 263 7th Ave, Suite 4H, Brooklyn, NY, 11215, USA
| | - Evelyn Taiwo
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Medical Oncology, 263 7th Ave, Suite 4H, Brooklyn, NY, 11215, USA
| | - Onyinye Balogun
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Radiation Oncology, 506 6th Street, Brooklyn, NY, 11215, USA
| | - Beth Siegel
- New York Presbyterian - Queens Hospital, Department of Breast Surgery, 56-45 Main Street Queens, NY, 11355, USA
| | - Agnes Radzio
- New York Presbyterian - Queens Hospital, Department of Breast Surgery, 56-45 Main Street Queens, NY, 11355, USA
| | - Lauren Elreda
- New York Presbyterian - Queens Hospital, Department of Medical Oncology, 56-45 Main Street Queens, NY, 11355, USA
| | - Yalei Chen
- Henry Ford Health System, Department of Surgery, 1 Ford Place, Detroit, MI, 48202, USA
| | - Lisa Newman
- New York Presbyterian-Weill Cornell Medicine, Department of Breast Surgery, 1283 York Avenue, 4th Floor, New York, NY, 10065, USA.
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48
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Johnson KJ, Goss CW, Thompson JJ, Trolard AM, Maricque BB, Anwuri V, Cohen R, Donaldson K, Geng E. Assessment of the impact of the COVID-19 pandemic on health services use. PUBLIC HEALTH IN PRACTICE 2022; 3:100254. [PMID: 35403073 PMCID: PMC8979834 DOI: 10.1016/j.puhip.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives The coronavirus disease of 2019 (COVID-19) pandemic declared by the World Health Organization on March 11, 2020 impacted healthcare services with provider and patient cancellations, delays, and patient avoidance or delay of emergency department or urgent care. Limited data exist on the population proportion affected by delayed healthcare, which is important for future healthcare planning efforts. Our objective was to evaluate the impact of the COVID-19 pandemic on healthcare service cancellations or delays and delays/avoidance of emergency/urgent care overall and by population characteristics. Study design This was a cross-sectional study. Methods Our sample (n = 2314) was assembled through a phone survey from 8/12/2020–10/27/2020 among non-institutionalized St. Louis County, Missouri, USA residents ≥18 years. We asked about provider and patient-initiated cancellations or delays of appointments and pandemic-associated delays/avoidance of emergency/urgent care overall and by participant characteristics. We calculated weighted prevalence estimates by select resident characteristics. Results Healthcare services cancellations or delays affected ∼54% (95% CI 50.6%–57.1%) of residents with dental (31.1%, 95% CI 28.1%–34.0%) and primary care (22.1%, 95% CI 19.5%–24.6%) being most common. The highest prevalences were among those who were White, ≥65 years old, female, in fair/poor health, who had health insurance, and who had ≥1 medical condition. Delayed or avoided emergency/urgent care impacted ∼23% (95% CI 19.9%–25.4%) of residents with a higher prevalence in females than males. Conclusions Healthcare use disruptions impacted a substantial proportion of residents. Future healthcare planning efforts should consider these data to minimize potential morbidity and mortality from delayed care.
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49
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Aoki T, Fujinuma Y, Matsushima M. Usual source of primary care and preventive care measures in the COVID-19 pandemic: a nationwide cross-sectional study in Japan. BMJ Open 2022; 12:e057418. [PMID: 35297779 PMCID: PMC8968108 DOI: 10.1136/bmjopen-2021-057418] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To assess multiple preventive care measures and to examine their associations with having a usual source of primary care and primary care performance during the COVID-19 pandemic in Japan. DESIGN Nationwide cross-sectional study. SETTING Japanese general adult population. PARTICIPANTS 1757 adult residents. PRIMARY OUTCOME MEASURES Fourteen preventive care measures aggregated the overall screening, immunisation and counselling composites. RESULTS Depression screening, zoster vaccination and tetanus vaccination had low implementation rates even among participants with a usual source of primary care. After adjustment for possible confounders, having a usual source of primary care was positively associated with all preventive care composites. Primary care performance assessed by the Japanese version of Primary Care Assessment Tool Short Form was also dose dependently associated with an increase in all composites. Results of the sensitivity analyses using a different calculation of preventive care composite were similar to those of the primary analyses. CONCLUSIONS Receipt of primary care, particularly high-quality primary care, contributed to increased preventive care utilisation even during the COVID-19 pandemic. However, the rate of mental health screening in primary care was at a very low level. Therefore, addressing mental health issues should be a major challenge for primary care providers during and after the pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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50
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Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1749. [PMID: 35162772 PMCID: PMC8834942 DOI: 10.3390/ijerph19031749] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services' use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services' use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic's impact on equity of access.
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Affiliation(s)
- Georgina Pujolar
- Health Policy Research Unit (SEPPS), Consorci de Salut i Social de Catalunya, 08022 Barcelona, Spain; (A.O.-A.); (I.V.); (M.-L.V.)
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