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Zattra O, Fraga A, Lu N, Gee MS, Liu RW, Lev MH, Brink JA, Saini S, Lang M, Succi MD. Trends in cancer imaging by indication, care setting, and hospital type during the COVID-19 pandemic and recovery at four hospitals in Massachusetts. Cancer Med 2021; 10:6327-6335. [PMID: 34355873 PMCID: PMC8420511 DOI: 10.1002/cam4.4183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to investigate the effects of COVID‐19 on computed tomography (CT) imaging of cancer. Methods Cancer‐related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre‐COVID‐19 (1/5/20–3/14/20), COVID‐19 peak (3/15/20–5/2/20), and post‐COVID‐19 peak (5/3/20–11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non‐urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university‐affiliated community hospital (UACH), and sole community hospitals (SCHs). Results During the COVID‐19 peak, a significant drop in CT volumes was observed (−42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively (p < 0.0001). In the post‐COVID‐19 peak period, cancer screening and initial workup CTs did not recover (−11.7%, p = 0.037; −20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline (p = 0.022) and the UACH a 41.5% increase (p < 0.001). Outpatient CTs recovered after the COVID‐19 peak, but with a shift in utilization away from the QAC (−8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED‐based oncologic CTs increased post‐peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively). Conclusions Cancer imaging was severely impacted during the COVID‐19 pandemic. CTs for cancer screening and initial workup did not recover to pre‐COVID‐19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.
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Affiliation(s)
- 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
| | - Anthony Fraga
- 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
| | - Nancy Lu
- 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
| | - Raymond W 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
| | - James A Brink
- 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
| | - 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
| | - 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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Alpert JM, Markham MJ, Bjarnadottir RI, Bylund CL. Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:16-24. [PMID: 31342283 DOI: 10.1007/s13187-019-01592-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA.
| | - Merry Jennifer Markham
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | | | - Carma L Bylund
- College of Journalism and Communications / College of Medicine, University of Florida, Gainesville, FL, USA
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