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Gete M, Huang SH, Ringash J, Irish J, Su J, Ballal Y, Waldron JN, Witterick I, de Almeida J, Hosni A, Hope AJ, Monteiro E, Cho J, O'Sullivan B, Kim J, Bratman S, Goldstein DP, McPartlin A, Tsai J, Tong L, Xu W, Hahn E. Causes and impact of delays during the COVID-19 pandemic on head and neck cancer diagnosis. Head Neck 2024; 46:2197-2205. [PMID: 38665037 DOI: 10.1002/hed.27784] [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: 12/26/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND The causes for delays during the COVID19 pandemic and their impact on head and neck cancer (HNC) diagnosis and staging are not well described. METHODS Two cohorts were defined a priori for review and analysis-a Pre-Pandemic cohort (June 1 to December 31, 2019) and a Pandemic cohort (June 1 to December 31, 2020). Delays were categorized as COVID-19 related or not, and as clinician, patient, or policy related. RESULTS A total of 638 HNC patients were identified including 327 in the Pre-Pandemic Cohort and 311 in the Pandemic Cohort. Patients in the Pandemic cohort had more N2-N3 category (41% vs. 33%, p = 0.03), T3-T4 category (63% vs. 50%, p = 0.002), and stage III-IV (71% vs. 58%, p < 0.001) disease. Several intervals in the diagnosis to treatment pathway were significantly longer in the pandemic cohort as compared to the Pre-Pandemic cohort. Among the pandemic cohort, 146 (47%) experienced a delay, with 112 related to the COVID-19 pandemic; 80 (71%) were clinician related, 15 (13%) were patient related, and 17 (15%) were policy related. CONCLUSIONS Patients in the Pandemic cohort had higher stage disease at diagnosis and longer intervals along the diagnostic pathway, with COVID-19 related clinician factors being the most common cause of delay.
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Affiliation(s)
- Maru Gete
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Canada
| | - Yashi Ballal
- Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
- The Michener Institute / University of Toronto, Toronto, Canada
| | - John N Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Andrew McPartlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Jillian Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
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Tu K, Lapadula MC, Apajee J, Bonilla AO, Baste V, Cuba-Fuentes MS, de Lusignan S, Flottorp S, Gaona G, Goh LH, Hallinan CM, Kristiansson RS, Laughlin A, Li Z, Ling ZJ, Manski-Nankervis JA, Ng APP, Scattini LF, Silva-Valencia J, Pace WD, Wensaas KA, Wong WCW, Zingoni PL, Westfall JM. Changes in reasons for visits to primary care after the start of the COVID-19 pandemic: An international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003406. [PMID: 39173045 PMCID: PMC11341054 DOI: 10.1371/journal.pgph.0003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The COVID-19 pandemic has reshaped healthcare delivery worldwide. OBJECTIVE To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID). METHODS We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods. RESULTS There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care. CONCLUSIONS The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries.
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Affiliation(s)
- Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- North York General Hospital, Toronto, Canada
- Toronto Western Hospital, Family Health Team, University Health Network, Toronto, Canada
| | - María C. Lapadula
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jemisha Apajee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - María S. Cuba-Fuentes
- Center for Research in Primary Health Care (CINAPS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Gabriela Gaona
- DARTNet Institute, Aurora, Colorado, United States of America
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christine M. Hallinan
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | | | - Adrian Laughlin
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Zhuo Li
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
| | - Zheng J. Ling
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Primary Care and Family Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Amy P. P. Ng
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Luciano F. Scattini
- Ministry of Health of the Autonomous City of Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | | | - Wilson D. Pace
- DARTNet Institute, Aurora, Colorado, United States of America
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, University of Hong Kong, Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Paula L. Zingoni
- Ministry of Health of the Autonomous City of Buenos Aires, Autonomous City of Buenos Aires, Argentina
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Devotta K, O’Campo P, Bender J, Lofters AK. Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers. Curr Oncol 2024; 31:4038-4051. [PMID: 39057173 PMCID: PMC11276223 DOI: 10.3390/curroncol31070301] [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: 06/18/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.
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Affiliation(s)
- Kimberly Devotta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B1W8, Canada
| | - Jacqueline Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- University Health Network, Toronto, ON M5G2C4, Canada
| | - Aisha K. Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
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4
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Chen KY, Stanford O, Wenzel JA, Joyner RL, Dobs AS. Patient perspectives on cancer care during COVID-19: A qualitative study. PLoS One 2024; 19:e0306035. [PMID: 38990967 PMCID: PMC11238955 DOI: 10.1371/journal.pone.0306035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE The COVID-19 pandemic posed unique challenges to cancer-related care as health systems balanced competing risks of timely delivery of care and minimizing exposure to infection in a high-risk, immunocompromised patient population. This study aimed to better understand how pandemic-related factors affected the patient experience of cancer care during this time. METHODS We conducted fifteen semi-structured interviews with adults from rural counties in Maryland who were diagnosed with and/or actively treated for cancer at the TidalHealth healthcare network between January 2020 and October 2022. RESULTS Interviews from fifteen participants were analyzed. Two major themes emerged including COVID Impact on Care, and COVID Impact on Mental Health. Subthemes under COVID Impact on Care include Staffing Shortages, Hospital Regulations, Visitation, Importance of Advocacy, and Telehealth Utilization, and subthemes under COVID Impact on Mental Health include Loneliness, Support Networks, and Perceptions of COVID and Personal Protection. Overall, participants described positive care experiences despite notable delays, disruptions to continuity of care, difficult transitions to telemedicine, visitation policies that limited patient support, increased mental health struggles related to social distancing measures, and greater desire for patient advocacy. CONCLUSION Our findings reveal significant impacts of the COVID-19 pandemic on experiences of cancer treatment and survivorship in a more vulnerable, rural patient population with lower healthcare access and income level. Our findings suggest areas for targeted interventions to limit disruptions to quality care in future public health emergencies.
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Affiliation(s)
- Krista Y. Chen
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Olivia Stanford
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Office of Community Outreach and Engagement, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jennifer A. Wenzel
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert L. Joyner
- Richard A. Henson Research Institute, TidalHealth Peninsula Regional, Salisbury, Maryland, United States of America
| | - Adrian S. Dobs
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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5
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Boyer L, Pauly V, Brousse Y, Orleans V, Tran B, Yon DK, Auquier P, Fond G, Duclos A. The impact of hospital saturation on non-COVID-19 hospital mortality during the pandemic in France: a national population-based cohort study. BMC Public Health 2024; 24:1798. [PMID: 38970000 PMCID: PMC11227237 DOI: 10.1186/s12889-024-19282-3] [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: 02/20/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. The primary objective was to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital mortality during the first year of the pandemic in France. METHODS We conducted a nationwide population-based cohort study including all adult patients hospitalized for non-COVID-19 acute medical conditions in France between March 1, 2020 and 31 May, 2020 (1st wave) and September 1, 2020 and December 31, 2020 (2nd wave). Hospital saturation was categorized into four levels based on weekly bed occupancy for COVID-19: no saturation (< 5%), low saturation (> 5% and ≤ 15%), moderate saturation (> 15% and ≤ 30%), and high saturation (> 30%). Multivariate generalized linear model analyzed the association between hospital saturation and mortality with adjustment for age, sex, COVID-19 wave, Charlson Comorbidity Index, case-mix, source of hospital admission, ICU admission, category of hospital and region of residence. RESULTS A total of 2,264,871 adult patients were hospitalized for acute medical conditions. In the multivariate analysis, the hospital mortality was significantly higher in low saturated hospitals (adjusted Odds Ratio/aOR = 1.05, 95% CI [1.34-1.07], P < .001), moderate saturated hospitals (aOR = 1.12, 95% CI [1.09-1.14], P < .001), and highly saturated hospitals (aOR = 1.25, 95% CI [1.21-1.30], P < .001) compared to non-saturated hospitals. The proportion of deaths outside ICU was higher in highly saturated hospitals (87%) compared to non-, low- or moderate saturated hospitals (81-84%). The negative impact of hospital saturation on mortality was more pronounced in patients older than 65 years, those with fewer comorbidities (Charlson 1-2 and 3 vs. 0), patients with cancer, nervous and mental diseases, those admitted from home or through the emergency room (compared to transfers from other hospital wards), and those not admitted to the intensive care unit. CONCLUSIONS Our study reveals a noteworthy "dose-effect" relationship: as hospital saturation intensifies, the non-COVID-19 hospital mortality risk also increases. These results raise concerns regarding hospitals' resilience and patient safety, underscoring the importance of identifying targeted strategies to enhance resilience for the future, particularly for high-risk patients.
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Affiliation(s)
- Laurent Boyer
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France.
| | - Vanessa Pauly
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Yann Brousse
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Veronica Orleans
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Bach Tran
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Pascal Auquier
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Guillaume Fond
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Antoine Duclos
- RESHAPE - Research on Healthcare Performance Lab, Inserm U1290, Claude Bernard Lyon 1 University, Lyon, 69424, France
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Sriharan A, Sekercioglu N, Berta W, Boet S, Laporte A, Strudwick G, Senkaiahliyan S, Ratnapalan S. Addressing the health human resources crisis: Strategies for retaining women health care professionals in organizations. PLoS One 2024; 19:e0293107. [PMID: 38870169 PMCID: PMC11175397 DOI: 10.1371/journal.pone.0293107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/12/2024] [Indexed: 06/15/2024] Open
Abstract
Globally, healthcare systems are contending with a pronounced health human resource crisis marked by elevated rates of burnout, heightened job transitions, and an escalating demand for the limited supply of the existing health workforce. This crisis detrimentally affects the quality of patient care, contributing to long wait times, decreased patient satisfaction, and a heightened frequency of patient safety incidents and medical errors. In response to the heightened demand, healthcare organizations are proactively exploring solutions to retain their workforce. With women comprising over 70% of health human resources, this study seeks to gain insight into the unique experiences of women health professionals on the frontlines of healthcare and develop a conceptual framework aimed at facilitating organizations in effectively supporting the retention and advancement of women in healthcare frontline roles. We used grounded theory in this qualitative study. From January 2023 to May 2023, we conducted individual semi-structured interviews with 27 frontline HCWs working in Canada and representing diverse backgrounds. The data underwent thematic analysis, which involved identifying and comprehending recurring patterns across the information to elucidate emerging themes. Our analysis found that organizational, professional, and personal factors shape women's intentions to leave the frontline workforce. Reevaluating organizational strategies related to workforce, fostering a positive work culture, and building the capacity of management to create supportive work environment can collectively transform the work environment. By creating conditions that enable women to perform effectively and find satisfaction in their professional roles, organizations can enhance their ability to retain valuable talent.
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Affiliation(s)
- Abi Sriharan
- Krembil Centre for Health Management and Leadership, Schulich School of Business, York University, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nigar Sekercioglu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Senthujan Senkaiahliyan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Savithiri Ratnapalan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Hospital for Sick Children, Toronto, Canada
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Telesnicki TT, Simpson AN, de Mestral C, Baxter NN, Urbach DR, Gomez D. Recommendations for Recovery of the COVID-19 Pandemic-related Diagnostic, Screening, and Procedure Backlog in Ontario: A Survey of Healthcare Leaders. CLIN INVEST MED 2024; 47:4-11. [PMID: 38958478 DOI: 10.3138/cim-2024-2655] [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] [Indexed: 07/04/2024]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership positions is urgently needed to inform a comprehensive provincial recovery strategy. METHODS A list of 20 policy recommendations addressing the diagnostic, screening and procedure backlog in Ontario were transformed into a national online survey. Policy recommendations were rated on a 7-point Likert scale (strongly agree to strongly disagree) and organized into those retained (≥75% strongly agree to somewhat agree), discarded (≥80% somewhat disagree to strongly disagree), and no consensus reached. Survey participants included a diverse sample of healthcare leaders with the potential to impact policy reform. RESULTS Of 56 healthcare leaders invited to participate, there were 34 unique responses (61% response rate). Participants were from diverse clinical backgrounds, including surgical subspecialties, medicine, nursing, and healthcare administration and held institutional or provincial leadership positions. A total of 11 of 20 policy recommendations reached the threshold for consensus agreement with the remaining 9 having no consensus reached. CONCLUSION Consensus agreement was reached among Canadian healthcare leaders on 11 policy recommendations to address the diagnostic, screening, and procedure backlog in Ontario. Recommendations included strategies to address patient information needs on expected wait times, expand health and human resource capacity, and streamline efficiencies to increase operating room output. No consensus was reached on the optimal funding strategy within the public system in Ontario or the appropriateness of implementing private funding models.
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Affiliation(s)
- Teagan T Telesnicki
- Department of General Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrea N Simpson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David R Urbach
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of General Surgery, Women's College Hospital, Toronto, ON, Canada
| | - David Gomez
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Division of General Surgery, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
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9
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Śliwczyński A, Jewczak M, Furlepa K, Gołębiak I, Rzeźnicki A, Marczak M, Ptak-Chmielewska A, Olszewski P, Orlewska K, Wierzba W, Nojszewska E, Orlewska E. Assessment of the dynamics of inpatient health care delivery in Poland before and throughout the COVID-19 pandemic. Sci Rep 2024; 14:11975. [PMID: 38796493 PMCID: PMC11127990 DOI: 10.1038/s41598-024-62671-2] [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: 07/21/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
A situation of emergency involving the whole population introduces changes in the dynamics of the health services that are provided. The magnitude of these shifts should be also linked to the medical speciality within which the health benefits are delivered. The aim of the paper was to identify changes in tendencies in inpatient medical service delivery during the COVID-19 pandemic by medical specialties. On the basis of a database extracted for in-patient treatment received from the public payer, a retrospective analysis was carried out. Comparing the values of the dynamics of the services provided in each medical speciality, the period before the COVID-19 pandemic was collated to the years of the pandemic (2020-2021). In the period before COVID-19, positive patient dynamics were observed in more than half of the specialities. Between 2020 and 2021, virtually all specialties reversed the trend and negative dynamics were recorded. The dynamics in 2021 indicate a process of return to the values from 2015 to 2019. Emergency situation has affected the dynamics of healthcare provision in different specialities to various extent. The most resistant to the negative impulses of the state of emergency were the areas that are strictly organisationally and financially defined (e.g. the group of "therapeutic and drug programmes").
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Affiliation(s)
| | - Maciej Jewczak
- Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz, Lodz, Poland
| | | | | | - Adam Rzeźnicki
- Department of Social Medicine, Medical University of Lodz, Lodz, Poland
| | - Michał Marczak
- Collegium of Management WSB, University of Warsaw, Warsaw, Poland
| | - Aneta Ptak-Chmielewska
- Warsaw School of Economics, Collegium of Economic Analysis, Institute of Statistics and Demography, Warsaw, Poland
| | - Paweł Olszewski
- Institute of Political Studies of the Polish Academy of Sciences, Warsaw, Poland
| | | | | | - Ewelina Nojszewska
- Department of Applied Economics, Collegium of Management and Finance, Warsaw School of Economics, Warsaw, Poland
| | - Ewa Orlewska
- Collegium Medicum Jan Kochanowski University Kielce, Polska, Poland
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10
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Vu TT, Weiss M, Nguyen LTH, Tran HT, Ho HT, Ngo VK. Adult cancer patients' barriers to and satisfaction with care at a National Cancer Hospital in Vietnam. PLoS One 2024; 19:e0303157. [PMID: 38722943 PMCID: PMC11081246 DOI: 10.1371/journal.pone.0303157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/03/2024] [Indexed: 05/13/2024] Open
Abstract
STUDY OBJECTIVE This study assessed the overall satisfaction with oncological care, including barriers to care, and identified its associated predictors among adult cancer patients in Vietnam. METHODS In this cross-sectional study, we enrolled 300 adult cancer patients receiving inpatient care at a large urban oncological hospital between June and July 2022. Multivariable linear regression analyses examined associations between patient experiences and overall satisfaction ratings with cancer care. RESULTS The mean overall satisfaction with oncological care was 8.82 out of 10, with 98.0% recommending this facility to their friends and family. In an adjusted model, being female (β = 0.29, 95%CI: 0.04, 0.53), endorsing satisfaction with patient-nurse communication (β = 0.33, 95%CI: 0.13, 0.53), patient-doctor communication (β = 0.40, 95%CI: 0.11, 0.70), and psychoeducation about oncological medication management (β = 0.30, 95%CI: 0.14, 0.45) were positively associated with overall ratings. In contrast, individuals with delays in treatment scheduling reported lower overall satisfaction with oncological care (β = -0.38, 95%CI: -0.64, -0.13). Patients perceived health system, social/environmental, and individual barriers to care: worries about income loss due to attending treatment (43.3%); fear, depression, anxiety, and distress (36.8%); concerns about affordability of treatment (36.7%) and transportation problems (36.7%); and excessive waiting times for appointments (28.8%). CONCLUSION This study showed high overall patient satisfaction with cancer care quality. Patient-centered communication strategies and psychoeducation about oncological medication management may be targeted to further enhance the cancer inpatient experience. Raising awareness about treatment options and services, and integrating mental health awareness into oncological care may ameliorate patient distress and facilitate greater satisfaction with oncological treatment processes.
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Affiliation(s)
- Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, New York, United States of America
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, New York, United States of America
| | - Marina Weiss
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, New York, United States of America
| | | | | | - Hien Thi Ho
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Victoria Khanh Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, New York, United States of America
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, New York, United States of America
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11
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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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12
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Powis M, Sutradhar R, Singh S, Alibhai S, Hack S, Baiad A, Chen K, Li H, Mohmand Z, Krzyzanowska MK. The Impact of the Pandemic on the Quality of Colorectal and Anal Cancer Care, and 2-Year Clinical Outcomes. Curr Oncol 2024; 31:2328-2340. [PMID: 38668076 PMCID: PMC11048770 DOI: 10.3390/curroncol31040173] [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: 02/27/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
We undertook a retrospective study to compare the quality of care delivered to a cohort of newly diagnosed adults with colon, rectal or anal cancer during the early phase of COVID-19 (02/20-12/20) relative to the same period in the year prior (the comparator cohort), and examine the impact of the pandemic on 2-year disease progression and all-cause mortality. We observed poorer performance on a number of quality measures, such as approximately three times as many patients in the COVID-19 cohort experienced 30-day post-surgical readmission (10.5% vs. 3.6%; SD:0.27). Despite these differences, we observed no statistically significant adjusted associations between COVID-19 and time to either all-cause mortality (HR: 0.88, 95% CI: 0.61-1.27, p = 0.50) or disease progression (HR: 1.16, 95% CI: 0.82-1.64, p = 0.41). However, there was a substantial reduction in new patient consults during the early phase of COVID-19 (12.2% decrease), which appeared to disproportionally impact patients who traditionally experience sociodemographic disparities in access to care, given that the COVID-19 cohort skewed younger and there were fewer patients from neighborhoods with the highest Housing and Dwelling, ands Age and Labour Force marginalization quintiles. Future work is needed to understand the more downstream effects of COVID-19 related changes on cancer care to inform planning for future disruptions in care.
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Affiliation(s)
- Melanie Powis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Shabbir Alibhai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Saidah Hack
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
| | - Abed Baiad
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Kevin Chen
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Huaqi Li
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Zuhal Mohmand
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Monika K. Krzyzanowska
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
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13
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Gore JL, Follmer K, Reynolds J, Nash M, Anderson CB, Catto JWF, Chamie K, Daneshmand S, Dickstein R, Garg T, Gilbert SM, Guzzo TJ, Kamat AM, Kates MR, Lane BR, Lotan Y, Mansour AM, Master VA, Montgomery JS, Morris DS, Nepple KG, O'Neil BB, Patel S, Pohar K, Porten SP, Riggs SB, Sankin A, Scarpato KR, Shore ND, Steinberg GD, Strope SA, Taylor JM, Comstock BA, Kessler LG, Wolff EM, Smith AB. Interruptions in bladder cancer care during the COVID-19 public health emergency. Urol Oncol 2024; 42:116.e17-116.e21. [PMID: 38087711 DOI: 10.1016/j.urolonc.2023.11.010] [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: 07/25/2023] [Revised: 10/19/2023] [Accepted: 11/10/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Academic and community urology centers participating in a pragmatic clinical trial in non-muscle-invasive bladder cancer completed monthly surveys assessing restrictions in aspects of bladder cancer care due to the COVID-19 Public Health Emergency. Our objective was to describe pandemic-related restrictions on bladder cancer care. METHODS We invited 32 sites participating in a multicenter pragmatic bladder cancer trial to complete monthly surveys distributed through REDCap beginning in May 2020. These surveys queried sites on whether they were experiencing restrictions in the use of elective surgery, transurethral resection of bladder tumors (TURBT), radical cystectomy, office cystoscopy, and intravesical bacillus Calmette-Guerin (BCG) availability. Responses were collated with descriptive statistics. RESULTS Of 32 eligible sites, 21 sites had at least a 50% monthly response rate over the study period and were included in the analysis. Elective surgery was paused at 76% of sites in May 2020, 48% of sites in January 2021, and 52% of sites in January 2022. Over those same periods, coinciding with COVID-19 incidence waves, TURBT was restricted at 10%, 14%, and 14% of sites, respectively, radical cystectomy was restricted at 10%, 14%, and 19% of sites, respectively, and cystoscopy was restricted at 33%, 0%, and 10% of sites, respectively. CONCLUSIONS Bladder cancer care was minimally restricted compared with more pronounced restrictions seen in general elective surgeries during the COVID-19 pandemic.
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Affiliation(s)
- John L Gore
- Department of Urology, University of Washington, Seattle, WA.
| | - Kristin Follmer
- Department of Urology, University of Washington, Seattle, WA
| | - Jason Reynolds
- Department of Urology, University of Washington, Seattle, WA
| | - Michael Nash
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - James W F Catto
- Department of Urology, Sheffield Teaching Hospitals NHS (National Health Service) Foundation Trust, Sheffield, United Kingdom
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore Washington Medical Center, Glen Burnie, MD; Chesapeake Urology, Baltimore, MD
| | - Tullika Garg
- Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Scott M Gilbert
- Division of Genitourinary Oncology, H.Lee Moffitt Cancer Center and Research Institute, Tampa FL
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Max R Kates
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Brian R Lane
- Division of Urology, Spectrum Health, Grand Rapids, MI
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX
| | - Viraj A Master
- Department of Urology and Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | | | - Brock B O'Neil
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sanjay Patel
- Department of Urology, University of Oklahoma, Oklahoma City, OK
| | - Kamal Pohar
- Department of Urology, The Ohio State University, Columbus, OH
| | - Sima P Porten
- Department of Urology, UCSF School of Medicine, San Francisco, CA
| | - Stephen B Riggs
- Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
| | - Gary D Steinberg
- Department of Urology, Rush University Medical Center, Chicago, IL
| | | | - Jennifer M Taylor
- Michael E. DeBakey VAMC, Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Larry G Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA
| | - Angela B Smith
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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14
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Iqbal J, Moineddin R, Fowler RA, Krzyzanowska MK, Booth CM, Downar J, Lau J, Le LW, Rodin G, Seow H, Tanuseputro P, Earle CC, Quinn KL, Hannon B, Zimmermann C. Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19. JAMA Netw Open 2024; 7:e240503. [PMID: 38411960 PMCID: PMC10900963 DOI: 10.1001/jamanetworkopen.2024.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Importance The COVID-19 pandemic had a profound impact on the delivery of cancer care, but less is known about its association with place of death and delivery of specialized palliative care (SPC) and potential disparities in these outcomes. Objective To evaluate the association of the COVID-19 pandemic with death at home and SPC delivery at the end of life and to examine whether disparities in socioeconomic status exist for these outcomes. Design, Setting, and Participants In this cohort study, an interrupted time series analysis was conducted using Ontario Cancer Registry data comprising adult patients aged 18 years or older who died with cancer between the pre-COVID-19 (March 16, 2015, to March 15, 2020) and COVID-19 (March 16, 2020, to March 15, 2021) periods. The data analysis was performed between March and November 2023. Exposure COVID-19-related hospital restrictions starting March 16, 2020. Main Outcomes and Measures Outcomes were death at home and SPC delivery at the end of life (last 30 days before death). Socioeconomic status was measured using Ontario Marginalization Index area-based material deprivation quintiles, with quintile 1 (Q1) indicating the least deprivation; Q3, intermediate deprivation; and Q5, the most deprivation. Segmented linear regression was used to estimate monthly trends in outcomes before, at the start of, and in the first year of the COVID-19 pandemic. Results Of 173 915 patients in the study cohort (mean [SD] age, 72.1 [12.5] years; males, 54.1% [95% CI, 53.8%-54.3%]), 83.7% (95% CI, 83.6%-83.9%) died in the pre-COVID-19 period and 16.3% (95% CI, 16.1%-16.4%) died in the COVID-19 period, 54.5% (95% CI, 54.2%-54.7%) died at home during the entire study period, and 57.8% (95% CI, 57.5%-58.0%) received SPC at the end of life. In March 2020, home deaths increased by 8.3% (95% CI, 7.4%-9.1%); however, this increase was less marked in Q5 (6.1%; 95% CI, 4.4%-7.8%) than in Q1 (11.4%; 95% CI, 9.6%-13.2%) and Q3 (10.0%; 95% CI, 9.0%-11.1%). There was a simultaneous decrease of 5.3% (95% CI, -6.3% to -4.4%) in the rate of SPC at the end of life, with no significant difference among quintiles. Patients who received SPC at the end of life (vs no SPC) were more likely to die at home before and during the pandemic. However, there was a larger immediate increase in home deaths among those who received no SPC at the end of life vs those who received SPC (Q1, 17.5% [95% CI, 15.2%-19.8%] vs 7.6% [95% CI, 5.4%-9.7%]; Q3, 12.7% [95% CI, 10.8%-14.5%] vs 9.0% [95% CI, 7.2%-10.7%]). For Q5, the increase in home deaths was significant only for patients who did not receive SPC (13.9% [95% CI, 11.9%-15.8%] vs 1.2% [95% CI, -1.0% to 3.5%]). Conclusions and Relevance These findings suggest that the COVID-19 pandemic was associated with amplified socioeconomic disparities in death at home and SPC delivery at the end of life. Future research should focus on the mechanisms of these disparities and on developing interventions to ensure equitable and consistent SPC access.
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Affiliation(s)
- Javaid Iqbal
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medicine, University of Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, University Health Network, Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig C Earle
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Kieran L Quinn
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
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15
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Wen T, Emont J, Huang Y, Matsuo K, Hershman DL, Friedman AM, Wright JD. Trends in Cancer-Directed Surgery Rates Associated with the COVID-19 Pandemic. Ann Surg Oncol 2024; 31:731-734. [PMID: 38082166 DOI: 10.1245/s10434-023-14698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jordan Emont
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yongmei Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Koji Matsuo
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Alexander M Friedman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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16
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Duffy SW, de Jonge L, Duffy TE. Effects on Cancer Prevention from the COVID-19 Pandemic. Annu Rev Med 2024; 75:1-11. [PMID: 37625124 DOI: 10.1146/annurev-med-051022-122257] [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] [Indexed: 08/27/2023]
Abstract
The COVID-19 pandemic led to disruption of health services around the world, including cancer services. We carried out a narrative review of the effect of the pandemic on cancer prevention services, including screening. Services were severely affected in the early months of the pandemic, and in some areas are still recovering. Large numbers of additional cancers or additional late-stage cancers have been predicted to arise over the coming years as a result of this disruption. To minimize the effects on cancer outcomes, it is necessary to return as quickly as possible to prepandemic levels of screening and prevention activity or indeed to exceed these levels. The recovery of services should address health inequalities.
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Affiliation(s)
- Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom;
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands;
| | - Thomas E Duffy
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom;
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Swift BE, Mazuryk J, Yermakhanova O, Green B, Ferguson SR, Kupets R. Access to Surgery for Endometrial Cancer Patients During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102226. [PMID: 37742834 DOI: 10.1016/j.jogc.2023.102226] [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: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on endometrial cancer stage and surgical treatment in Ontario, Canada. METHODS This descriptive study identified cases from January 1, 2017 to December 31, 2021 from endometrial cancer hysterectomy specimens in the Ontario Health-Cancer Care Ontario, ePath system. Endometrial biopsy records from January 1, 2016 to December 31, 2021 were matched to surgical specimens by provincial health card number. Time to surgery and surgical stage were compared before (2017-2019) and during (2020-2021) the COVID-19 pandemic. RESULTS There were 10 446 women treated with hysterectomy for endometrial cancer in Ontario from 2017-2021. In April and May 2020, corresponding with the provincial state of emergency, there was a 56% relative reduction in endometrial biopsies. Despite this 2-month reduction in endometrial biopsy volume, there was no change in surgical volume for endometrial cancer treatment. The median time from endometrial biopsy to surgery was 56 days (IQR 40, 80) during the pandemic (2020-2021) compared to 58 days (IQR 43, 82) prior to the pandemic (2017-2019) (P < 0.001). There was no upstaging of endometrial cancer during the COVID-19 pandemic. CONCLUSIONS The Ontario healthcare system continued to prioritize service delivery to endometrial cancer patients during the COVID-19 pandemic, despite the increase in virtual care and decrease in operating room time. There were no significant surgical delays or upstaging of endometrial cancer.
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Affiliation(s)
- Brenna E Swift
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Division of Gynaecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | | | - Bo Green
- Ontario Health-Cancer Care Ontario, Toronto, ON
| | - Sarah R Ferguson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Division of Gynaecologic Oncology, University Health Network, Toronto, ON
| | - Rachel Kupets
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Division of Gynaecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON.
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18
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Fu R, Tinmouth J, Li Q, Dare A, Hallet J, Coburn N, Lapointe-Shaw L, Look Hong NJ, Karam I, Rabeneck L, Krzyzanowska M, Sutradhar R, Eskander A. COVID-19 pandemic impact on the potential exacerbation of screening mammography disparities: A population-based study in Ontario, Canada. Prev Med Rep 2024; 37:102578. [PMID: 38222304 PMCID: PMC10787238 DOI: 10.1016/j.pmedr.2023.102578] [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: 08/29/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024] Open
Abstract
Strategies to ramp up breast cancer screening after COVID-19 require data on the influence of the pandemic on groups of women with historically low screening uptake. Using data from Ontario, Canada, our objectives were to 1) quantify the overall pandemic impact on weekly bilateral screening mammography rates (per 100,000) of average-risk women aged 50-74 and 2) examine if COVID-19 has shifted any mammography inequalities according to age, immigration status, rurality, and access to material resources. Using a segmented negative binomial regression model, we estimated the mean change in rate at the start of the pandemic (the week of March 15, 2020) and changes in weekly trend of rates during the pandemic period (March 15-December 26, 2020) compared to the pre-pandemic period (January 3, 2016-March 14, 2020) for all women and for each subgroup. A 3-way interaction term (COVID-19*week*subgroup variable) was added to the model to detect any pandemic impact on screening disparities. Of the 3,481,283 mammograms, 8.6 % (n = 300,064) occurred during the pandemic period. Overall, the mean weekly rate dropped by 93.4 % (95 % CI 91.7 % - 94.8 %) at the beginning of COVID-19, followed by a weekly increase of 8.4 % (95 % CI 7.4 % - 9.4 %) until December 26, 2020. The pandemic did not shift any disparities (all interactions p > 0.05) and that women who were under 60 or over 70, immigrants, or with a limited access to material resources had persistently low screening rate in both periods. Interventions should proactively target these underserved populations with the goals of reducing advanced-stage breast cancer presentations and mortality.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Powis M, Sutradhar R, Hack S, Alibhai SM, Berlin A, Singh S, Krzyzanowska MK. Patient Perceptions of the Impact of the COVID Pandemic on the Quality of Their Gastrointestinal Cancer Care. J Patient Exp 2023; 10:23743735231223849. [PMID: 38162188 PMCID: PMC10757436 DOI: 10.1177/23743735231223849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
We surveyed patients who had a received care for a gastrointestinal cancer between 03/2020 and 05/2021 to understand their perceptions of the impact of the Covid pandemic on cancer care delivery and quality of care. Three-hundred fifty-eight respondents provided evaluable responses (response rate: 17.3%). Approximately half of respondents (46.4%) perceived that they had experienced a pandemic-related cancer care modification; most changes were initiated by a clinician or the cancer center (44.6%). Relative to White patients those from Racialized Groups (OR: 1.91, 95% CI: 1.03-3.54) were more likely to report a cancer treatment change. Additionally, relative to patients in follow-up, those who were newly diagnosed (OR: 2.39; 95% CI: 1.21-4.71) were more likely to report a change. Compared to White patients, patients from Racialized Groups were approximately twice as likely to report perceiving that virtual visits during Covid negatively impacted the quality of their care (OR: 2.21; 95% CI: 0.96-5.08). These findings potentially reflect pre-existing systemic disparities in quality of and access to care, as well as differences in how care is experienced by patients from Racialized Groups.
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Affiliation(s)
- Melanie Powis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Shabbir M.H. Alibhai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Simron Singh
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Monika K. Krzyzanowska
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
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20
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
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Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
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Lofters AK, Wu F, Frymire E, Kiran T, Vahabi M, Green ME, Glazier RH. Cancer Screening Disparities Before and After the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2343796. [PMID: 37983033 PMCID: PMC10660460 DOI: 10.1001/jamanetworkopen.2023.43796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/08/2023] [Indexed: 11/21/2023] Open
Abstract
Importance Breast, cervical, and colorectal cancer-screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic. Objective To assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income. Design, Setting, and Participants This population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country's most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed. Exposures Neighborhood income quintile, immigrant status, and primary care model type. Main Outcomes and Measures For each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years. Results The overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, -9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, -3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was -1.16 (95% CI, -1.56 to -0.77); for immigrant vs nonimmigrant, the β estimate was -1.51 (95% CI, -1.84 to -1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was -1.29 (95% CI, 16 -1.53 to -1.06); for immigrant vs nonimmigrant, the β estimate was -1.41 (95% CI, -1.61 to -1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models. Conclusions and Relevance In this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.
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Affiliation(s)
- Aisha K. Lofters
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Eliot Frymire
- Health Services and Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
- ICES Queen’s, Kingston, Ontario, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Michael E. Green
- Health Services and Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
- ICES Queen’s, Kingston, Ontario, Canada
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Richard H. Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
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Janczewski LM, Cotler J, Merkow RP, Palis B, Nelson H, Mullett T, Boffa DJ. Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2340148. [PMID: 37902756 PMCID: PMC10616721 DOI: 10.1001/jamanetworkopen.2023.40148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Importance The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear. Objective To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020. Main Outcomes and Measures The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years. Results Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks. Conclusions and Relevance This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.
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Affiliation(s)
- Lauren M. Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Joseph Cotler
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Ryan P. Merkow
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Bryan Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Timothy Mullett
- Department of Surgery, University of Kentucky College of Medicine, Lexington
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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23
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Unger JM, Stires H, Levit LA, Stewart M, McKelvey BA, Canin B, Dressler E, Flaherty K, Fredette P, Jones L, McCann P, Miller T, Onitilo AA, Palmieri F, Patel T, Paul R, Smith GL, Bruinooge SS, Garrett-Mayer E, Lei XJ, Alva A, Schenkel C. Sponsor Perspectives on the Impact of the COVID-19 Pandemic on Interventional Cancer Clinical Trial Protocols and Data Quality. JCO Oncol Pract 2023; 19:907-916. [PMID: 37643386 PMCID: PMC10615547 DOI: 10.1200/op.23.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The onset of the COVID-19 pandemic created major disruptions in the conduct of cancer clinical trials. In response, regulators and sponsors allowed modifications to traditional trial processes to enable clinical research and care to continue. We systematically evaluated how these mitigation strategies affected data quality and overall trial conduct. METHODS This study used surveys and live interviews. Forty-one major industry and National Cancer Institute Network groups (sponsors) overseeing anticancer treatment trials open in the United States from January 2015 to May 2022 were invited to participate. Descriptive statistics were used for survey data summaries. Key themes from interviews were identified. RESULTS Twenty sponsors (48.8%; 15 industry and five Network groups) completed the survey; 11/20 (55.0%) participated in interviews. Sponsors predominantly (n = 12; 60.0%) reported large (≥11 trials) portfolios of phase II and/or phase III trials. The proportion of sponsors reporting a moderate (9) or substantial (8) increase in protocol deviations in the initial pandemic wave versus the pre-pandemic period was 89.5% (17/19); the proportion reporting a substantial increased dropped from 42.1% (n = 8/19) in the initial wave to 15.8% (n = 3/19) thereafter. The most commonly adopted mitigation strategies were remote distribution of oral anticancer therapies (70.0%), remote adverse event monitoring (65.0%), and remote consenting (65.0%). Most respondents (15/18; 83.3%) reported that the pandemic had minimal (n = 14) or no impact (n = 1) on overall data integrity. CONCLUSION Despite nearly all sponsors observing a temporary increase in protocol deviations, most reported the pandemic had minimal/no impact on overall data integrity. The COVID-19 pandemic accelerated an emerging trend toward greater flexibility in trial conduct, with potential benefits of reduced burden on trial participants and sites and improved patient access to research.
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Affiliation(s)
| | | | - Laura A. Levit
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | | | | | - Peter Fredette
- EQRx (employed by IQVIA during study design phase), Cambridge, MA
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | | | - Therica Miller
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Timil Patel
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD
| | - Rocio Paul
- National Cancer Institute, Cancer Therapy Evaluation Program, Clinical Trials Monitoring Branch, Bethesda, MD
| | - Gary L. Smith
- National Cancer Institute, Cancer Therapy Evaluation Program, Clinical Trials Monitoring Branch, Bethesda, MD
| | | | | | - Xiudong Jennifer Lei
- University of Texas MD Anderson Cancer Center (employed by ASCO during study design phase), Houston, TX
| | - Ajjai Alva
- University of Michigan Medical Center, Ann Arbor, MI
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24
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [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] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
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Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
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25
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Zeitouny S, Cheung DC, Bremner KE, Pataky RE, Pequeno P, Matelski J, Peacock S, Del Giudice ME, Lapointe-Shaw L, Tomlinson G, Mendlowitz AB, Mulder C, Tsui TCO, Perlis N, Walker JD, Sander B, Wong WWL, Krahn MD, Kulkarni GS. The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis. PLoS One 2023; 18:e0290646. [PMID: 37682823 PMCID: PMC10490868 DOI: 10.1371/journal.pone.0290646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). METHODS This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. RESULTS The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. CONCLUSIONS Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.
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Affiliation(s)
- Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas C. Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E. Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Elisabeth Del Giudice
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Andrew B. Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Teresa C. O. Tsui
- ICES, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nathan Perlis
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer D. Walker
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - William W. L. Wong
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray D. Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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26
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Worthington J, van Wifferen F, Sun Z, de Jonge L, Lew JB, Greuter MJ, van den Puttelaar R, Feletto E, Lansdorp-Vogelaar I, Coupé VM, Ein Yong JH, Canfell K. Potential global loss of life expected due to COVID-19 disruptions to organised colorectal cancer screening. EClinicalMedicine 2023; 62:102081. [PMID: 37538541 PMCID: PMC10393619 DOI: 10.1016/j.eclinm.2023.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Screening for colorectal cancer (CRC) decreases cancer burden through removal of precancerous lesions and early detection of cancer. The COVID-19 pandemic has disrupted organised CRC screening programs worldwide, with some programs completely suspending screening and others experiencing significant decreases in participation and diagnostic follow-up. This study estimated the global impact of screening disruptions on CRC outcomes, and potential effects of catch-up screening. Methods Organised screening programs were identified in 29 countries, and data on participation rates and COVID-related changes to screening in 2020 were extracted where available. Four independent microsimulation models (ASCCA, MISCAN-Colon, OncoSim, and Policy1-Bowel) were used to estimate the long-term impact on CRC cases and deaths, based on decreases to screening participation in 2020. For countries where 2020 participation data were not available, changes to screening were approximated based on excess mortality rates. Catch-up strategies involving additional screening in 2021 were also simulated. Findings In countries for which direct data were available, organised CRC screening volumes at a country level decreased by an estimated 1.3-40.5% in 2020. Globally, it is estimated that COVID-related screening decreases led to a deficit of 7.4 million fewer faecal screens performed in 2020. In the absence of any organised catch-up screening, this would lead to an estimated 13,000 additional CRC cases and 7,900 deaths globally from 2020 to 2050; 79% of the additional cases and 85% of additional deaths could have been prevented with catch-up screening, respectively. Interpretation COVID-19-related disruptions to screening will cause excess CRC cases and deaths, but appropriately implemented catch-up screening could have reduced the burden by over 80%. Careful management of any disruption is key to improving the resilience of colorectal cancer screening programs. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Cancer Council New South Wales, Health Canada, and Dutch National Institute for Public Health and Environment.
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Affiliation(s)
- Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Francine van Wifferen
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Zhuolu Sun
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Marjolein J.E. Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Veerle M.H. Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Australia
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27
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Devotta K, Vahabi M, Prakash V, Lofters AK. Implementation of a Cervical Cancer Screening Intervention for Under- or Never-Screened Women in Ontario, Canada: Understanding the Acceptability of HPV Self-Sampling. Curr Oncol 2023; 30:6786-6804. [PMID: 37504357 PMCID: PMC10378307 DOI: 10.3390/curroncol30070497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing evidence and adoption of HPV testing for cervical screening has encouraged many jurisdictions around the world to move towards HPV testing, with the option of self-sampling. We conducted an intervention beginning in June 2018, where we recruited over 100 under- or never-screened (UNS) women who identify as South or West Asian, Middle Eastern or North African from the Greater Toronto Area, to understand the uptake and acceptability of HPV self-sampling as an alternative to a Pap test. Participants self-selected if they tried the kit or not and completed both quantitative and qualitative research activities. This paper focuses on the qualitative arm of the study, where follow-ups and five focus groups were conducted with those who tried the kit (three groups) and those who did not (two groups), as well as eight key informant interviews with community champions and others who were involved in our recruitment. We used the Consolidated Framework for Implementation Research (CFIR) to guide our data collection and analysis. Major themes around convenience, privacy and comfort came from the data as important drivers of the uptake of the intervention. The role of community champions and peers in engaging and educating UNS women, as well as having self-confidence to collect the sample, also came out as factors impacting uptake and plans for continued use. Overall, the intervention showed that HPV self-sampling is an acceptable alternative to a Pap test for some but not all UNS women in Ontario.
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Affiliation(s)
- Kimberly Devotta
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Vijayshree Prakash
- WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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28
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Yeo S, Lee U, Xu YH, Simmons C, Smrke A, Wang Y. Survival Outcomes of Ewing Sarcoma and Rhabdomyosarcoma by High- versus Low-Volume Cancer Centres in British Columbia, Canada. Diagnostics (Basel) 2023; 13:diagnostics13111973. [PMID: 37296824 DOI: 10.3390/diagnostics13111973] [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: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Due to the rarity and complexity of treatment for Ewing sarcoma and rhabdomyosarcoma, studies demonstrate improved patient outcomes when managed by a multidisciplinary team at high-volume centres (HVCs). Our study explores the difference in outcomes of Ewing sarcoma and rhabdomyosarcoma patients based on the centre of initial consultation in British Columbia, Canada. This retrospective study assessed adults diagnosed with Ewing sarcoma and rhabdomyosarcoma between 1 January 2000 and 31 December 2020 undergoing curative intent therapy in one of five cancer centres across the province. Seventy-seven patients were included, 46 seen at HVCs and 31 at low-volume centres (LVCs). Patients at HVCs were younger (32.1 vs. 40.8 years, p = 0.020) and more likely to receive curative intent radiation (88% vs. 67%, p = 0.047). The time from diagnosis to first chemotherapy was 24 days shorter at HVCs (26 vs. 50 days, p = 0.120). There was no significant difference in overall survival by treatment centre (HR 0.850, 95% CI 0.448-1.614). Variations in care exist amongst patients treated at HVCs vs. LVCs, which may reflect differences in access to resources, clinical specialists, and varying practice patterns across centres. This study can be used to inform decisions regarding triaging and centralization of Ewing sarcoma and rhabdomyosarcoma patient treatment.
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Affiliation(s)
- Sarah Yeo
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ursula Lee
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Surrey, Surrey, BC V3V 1Z2, Canada
| | - Ying Hui Xu
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine Simmons
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Alannah Smrke
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Ying Wang
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
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29
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Look Hong NJ, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Eskander A. Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study. CMAJ Open 2023; 11:E426-E433. [PMID: 37160325 PMCID: PMC10174267 DOI: 10.9778/cmajo.20220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). METHODS In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). RESULTS We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88-0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23-1.36) and 13% (rate ratio 1.13, 95% CI 1.07-1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002-1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989-0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994-0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24-31 weeks into the pandemic. INTERPRETATION An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.
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Affiliation(s)
- Rui Fu
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Rinku Sutradhar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Qing Li
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Timothy P Hanna
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Kelvin K W Chan
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Jonathan C Irish
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Natalie Coburn
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Julie Hallet
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Anna Dare
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Simron Singh
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ambica Parmar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Craig C Earle
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Lauren Lapointe-Shaw
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Monika K Krzyzanowska
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antonio Finelli
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alexander V Louie
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Nicole J Look Hong
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Ian J Witterick
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Alyson Mahar
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - David R Urbach
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Daniel I McIsaac
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Danny Enepekides
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont
| | - Antoine Eskander
- ICES (Fu, Sutradhar, Li, Coburn, Hallet, Dare, Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Urbach, McIsaac, Eskander); Institute of Health Policy, Management and Evaluation (Fu, Sutradhar, Chan, Irish, Coburn, Hallet, Dare, Singh, Lapointe-Shaw, Krzyzanowska, Finelli, Hong, Eskander) and Department of Otolaryngology - Head and Neck Surgery (Fu, Witterick, Enepekides, Eskander), University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Hanna), Cancer Research Institute, Queen's University, Kingston, Ont.; Ontario Institute for Cancer Research (Hanna); Odette Cancer Centre (Chan, Hallet), Sunnybrook Health Sciences Centre; Ontario Health (Chan, Coburn, Witterick) - Cancer Care Ontario; Department of Otolaryngology - Head and Neck Surgery (Irish, Witterick), University of Toronto, Princess Margaret Cancer Centre; Department of Surgery (Coburn, Hallet, Dare, Finelli, Hong) and Department of Medicine (Singh, Parmar, Earle, Lapointe-Shaw, Krzyzanowska), University of Toronto; Department of Radiation Oncology (Louie), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.; Department of Surgery (Urbach), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital, Ottawa, Ont.
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Heer E, Ruan Y, Pader J, Mah B, Ricci C, Nguyen T, Chow K, Ford-Sahibzada C, Gogna P, Poirier A, Forbes N, Heitman SJ, Hilsden RJ, Brenner DR. Performance of the fecal immunochemical test for colorectal cancer and advanced neoplasia in individuals under age 50. Prev Med Rep 2023; 32:102124. [PMID: 36875511 PMCID: PMC9981994 DOI: 10.1016/j.pmedr.2023.102124] [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: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
The increased demand for colonoscopy combined with increased incidence of colorectal cancer (CRC) among younger populations presents a need to determine FIT performance among individuals in this age group. We conducted a systematic review to assess test performance characteristics of FIT in detecting CRC and advanced neoplasia in younger age populations. A search through December 2022 identified published articles assessing the sensitivity and specificity of FIT for advanced neoplasia or CRC among populations under age 50. Following the search, 3 studies were included in the systematic review. Sensitivity to detect advanced neoplasia ranged from 0.19 to 0.36 and specificity between 0.94 and 0.97 and the overall sensitivity and specificity were 0.23 (0.17-0.30) and 0.96 (0.94-0.98), respectively. Two studies that assessed these metrics in multiple age categories found similar sensitivity and specificity across all age groups 30-49. Sensitivity and specificity to detect CRC was assessed in one study and found no significant differences by age groups. These results suggest that FIT performance may be lower for younger individuals compared to those typically screened for CRC. However, there were few studies available for analysis. Given increasing recommendations to expand screening in younger age groups, more research is needed to determine whether FIT is an adequate screening tool in this population.
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Affiliation(s)
- Emily Heer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Yibing Ruan
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Brittany Mah
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | | | - Teresa Nguyen
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Kristian Chow
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chelsea Ford-Sahibzada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Abbey Poirier
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steve J. Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert J. Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darren R. Brenner
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Corresponding author at: Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada.
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Fu R, Sutradhar R, Li Q, Kamalraj P, Dare A, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Louie AV, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Gomez D, Look Hong NJ, Tinmouth J, Eskander A. Early survival for patients newly diagnosed with cancer during COVID-19 in Ontario, Canada: A population-based cohort study. Cancer Med 2023. [PMID: 36999960 DOI: 10.1002/cam4.5861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Little is known about the association between the COVID-19 pandemic and early survival among newly diagnosed cancer patients. METHODS This retrospective population-based cohort study used linked administrative datasets from Ontario, Canada. Adults (≥18 years) who received a cancer diagnosis between March 15 and December 31, 2020, were included in a pandemic cohort, while those diagnosed during the same dates in 2018/2019 were included in a pre-pandemic cohort. All patients were followed for one full year after the date of diagnosis. Cox proportional hazards regression models were used to assess survival in relation to the pandemic, patient characteristics at diagnosis, and the modality of first cancer treatment as a time-varying covariate. Interaction terms were explored to measure the pandemic association with survival for each cancer type. RESULTS Among 179,746 patients, 53,387 (29.7%) were in the pandemic cohort and 37,741 (21.0%) died over the first post-diagnosis year. No association between the pandemic and survival was found when adjusting for patient characteristics at diagnosis (HR 0.99 [95% CI 0.96-1.01]), while marginally better survival was found for the pandemic cohort when the modality of treatment was additionally considered (HR 0.97 [95% CI 0.95-0.99]). When examining each cancer type, only a new melanoma diagnosis was associated with a worse survival in the pandemic cohort (HR 1.25 [95% CI 1.05-1.49]). CONCLUSIONS Among patients able to receive a cancer diagnosis during the pandemic, one-year overall survival was not different than those diagnosed in the previous 2 years. This study highlights the complex nature of the COVID-19 pandemic impact on cancer care.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Pabiththa Kamalraj
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, Ontario, Canada
| | - Simron Singh
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ambica Parmar
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Alyson Mahar
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - David R Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Gomez
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nicole J Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Liu Z, Zhang Z, Liu H, Chen J. Time to surgery does not affect oncologic outcomes in locally advanced gastric cancer after neoadjuvant chemotherapy: a meta-analysis. Future Oncol 2023; 19:397-408. [PMID: 36919890 DOI: 10.2217/fon-2022-1061] [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: 03/16/2023] Open
Abstract
Aim: The authors conducted a meta-analysis to determine the association between time-to-surgery (TTS) after neoadjuvant chemotherapy and patient outcomes in locally advanced gastric cancer. Methods: Electronic databases were searched to identify potential studies, in which the authors compared patient outcomes between those with TTS within 4 (and 6) weeks of completion of neoadjuvant chemotherapy and those after 4 (and 6) weeks. Results: Six studies, including 1238 patients, were eligible for inclusion. Pooled data showed no significant differences in rates of pathological complete response, major pathological response, ypN0, complications, R0 resection and operative time between groups of longer TTS and shorter TTS. Conclusion: There was no statistically advantageous impact of prolonged TTS on pathological and surgical outcomes. Large, population-based studies are warranted.
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Affiliation(s)
- Zining Liu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhening Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis & Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Liu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis & Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Junbing Chen
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Coburn N, Hallet J, Eskander A. Imaging and physician visits at cancer diagnosis: COVID -19 pandemic impact on cancer care. Cancer Med 2023; 12:6056-6067. [PMID: 36176264 PMCID: PMC10028129 DOI: 10.1002/cam4.5321] [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: 03/04/2022] [Revised: 08/09/2022] [Accepted: 09/21/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known about the COVID-19 pandemic impact on the provision of diagnostic imaging and physician visits at cancer diagnosis. METHODS We used administrative databases from Ontario, Canada, to identify MRI/CT/ultrasound scans and in-person/virtual physician visits conducted with cancer patients within 91 days around the date of diagnosis in 2016-2020. In separate segmented regression procedures, we assessed the trends in weekly volume of these services per thousand cancer patients in prepandemic (June 26, 2016 to March 14, 2020), the change in mean volume at the start of the pandemic, and the additional change in weekly volume during the pandemic (March 15, 2020, to September 26, 2020). RESULTS Totally, 403,561 cancer patients were included. On March 15, 2020 (COVID-19 arrived), mean scan volume decreased by 12.3% (95% CI: 6.4%-17.9%) where ultrasound decreased the most by 31.8% (95% CI: 23.9%-37.0%). Afterward, the volume of all scans increased further by 1.6% per week (95% CI: 1.3%-2.0%), where ultrasound increased the fastest by 2.4% (95% CI: 1.8%-2.9%). Mean in-person visits dropped by 47.4% when COVID-19 started (95% CI: 41.6%-52.6%) while virtual visits rose by 55.15-fold (95% CI: 4927%-6173%). In the pandemic (until September 26, 2020), in-person visits increased each week by 2.6% (95% CI: 2.0%-3.2%), but no change was observed for virtual visits (p -value = 0.10). CONCLUSIONS Provision of diagnostic imaging and virtual visits at cancer diagnosis has been increasing since the start of COVID-19 and has exceeded prepandemic utilization levels. Future work should monitor the impact of these shifts on quality of delivered care.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health - Cancer Care Ontario, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health - Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
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Prioritization of head and neck cancer patient care during the COVID-19 pandemic: a retrospective cohort study. J Otolaryngol Head Neck Surg 2023; 52:15. [PMID: 36782236 PMCID: PMC9925359 DOI: 10.1186/s40463-023-00625-w] [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: 09/07/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic placed considerable strain on the healthcare system, leading to the re-allocation of resources and implementation of new practice guidelines. The objective of this study is to assess the impact of COVID-19 guideline modifications on head and neck cancer (HNC) care at two tertiary care centers in Canada. METHODS A retrospective cohort study was conducted. HNC patients seen at two tertiary care centers before and after the onset of the COVID-19 pandemic (pre-pandemic: July 1st, 2019, to February 29th, 2020; pandemic: March 1st, 2020, to October 31st, 2020) were included. The pre-pandemic and pandemic cohorts were compared according to patient and tumor characteristics, duration of HNC workup, and treatment type and duration. Mean differences in cancer care wait times, including time to diagnosis, tumor board, and treatment as well as total treatment package time and postoperative hospital stay were compared between cohorts. Univariate and multivariate analyses were used to compare characteristics and outcomes between cohorts. RESULTS Pre-pandemic (n = 132) and pandemic (n = 133) patients did not differ significantly in sex, age, habits, or tumor characteristics. The percentage of patients who received surgery only, chemo/radiotherapy (CXRT) only, and surgery plus adjuvant CXRT did not differ significantly between cohorts. Pandemic patients experienced a significant time reduction compared to pre-pandemic patients with regards to the date first seen by a HNC service until start of treatment ([Formula: see text] = 48.7 and 76.6 days respectively; p = .0001), the date first seen by a HNC service until first presentation at tumor board ([Formula: see text] = 25.1 and 38 days respectively; p = .001), mean total package time for patients who received surgery only ([Formula: see text] = 3.7 and 9.0 days respectively; p = .017), and mean total package time for patients who received surgery plus adjuvant CXRT ([Formula: see text] = 80.2 and 112.7 days respectively; p = .035). CONCLUSION The time to treatment was significantly reduced during the COVID-19 pandemic as compared to pre-pandemic. This transparent model of patient-centered operative-room prioritization can serve as a model for improving resource allocation and efficiency of HNC care during emergency and non-emergency scenarios.
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Raman KS, Ninomiya MM, Bovill ES, Doherty C, Macadam SA, Laeken NV, Isaac KV. Temporal Sequencing of Multimodal Treatment in Immediate Breast Reconstruction and Implications for Wait Times: A Regional Canadian Cross-Sectional Study. Plast Surg (Oakv) 2023. [DOI: 10.1177/22925503231152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/− 19 vs 33.0 +/− 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy ( P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy ( n = 25, 53%) and transition to radiotherapy ( n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.
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Affiliation(s)
- Karanvir S. Raman
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maya Morton Ninomiya
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Tope P, Farah E, Ali R, El-Zein M, Miller WH, Franco EL. The impact of lag time to cancer diagnosis and treatment on clinical outcomes prior to the COVID-19 pandemic: A scoping review of systematic reviews and meta-analyses. eLife 2023; 12:81354. [PMID: 36718985 PMCID: PMC9928418 DOI: 10.7554/elife.81354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
Background The COVID-19 pandemic has disrupted cancer care, raising concerns regarding the impact of wait time, or 'lag time', on clinical outcomes. We aimed to contextualize pandemic-related lag times by mapping pre-pandemic evidence from systematic reviews and/or meta-analyses on the association between lag time to cancer diagnosis and treatment with mortality- and morbidity-related outcomes. Methods We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library of Systematic Reviews for reviews published prior to the pandemic (1 January 2010-31 December 2019). We extracted data on methodological characteristics, lag time interval start and endpoints, qualitative findings from systematic reviews, and pooled risk estimates of mortality- (i.e., overall survival) and morbidity- (i.e., local regional control) related outcomes from meta-analyses. We categorized lag times according to milestones across the cancer care continuum and summarized outcomes by cancer site and lag time interval. Results We identified 9032 records through database searches, of which 29 were eligible. We classified 33 unique types of lag time intervals across 10 cancer sites, of which breast, colorectal, head and neck, and ovarian cancers were investigated most. Two systematic reviews investigating lag time to diagnosis reported different findings regarding survival outcomes among paediatric patients with Ewing's sarcomas or central nervous system tumours. Comparable risk estimates of mortality were found for lag time intervals from surgery to adjuvant chemotherapy for breast, colorectal, and ovarian cancers. Risk estimates of pathologic complete response indicated an optimal time window of 7-8 weeks for neoadjuvant chemotherapy completion prior to surgery for rectal cancers. In comparing methods across meta-analyses on the same cancer sites, lag times, and outcomes, we identified critical variations in lag time research design. Conclusions Our review highlighted measured associations between lag time and cancer-related outcomes and identified the need for a standardized methodological approach in areas such as lag time definitions and accounting for the waiting-time paradox. Prioritization of lag time research is integral for revised cancer care guidelines under pandemic contingency and assessing the pandemic's long-term effect on patients with cancer. Funding The present work was supported by the Canadian Institutes of Health Research (CIHR-COVID-19 Rapid Research Funding opportunity, VR5-172666 grant to Eduardo L. Franco). Parker Tope, Eliya Farah, and Rami Ali each received an MSc. stipend from the Gerald Bronfman Department of Oncology, McGill University.
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Affiliation(s)
- Parker Tope
- Division of Cancer Epidemiology, McGill UniversityMontrealCanada
| | - Eliya Farah
- Division of Cancer Epidemiology, McGill UniversityMontrealCanada
| | - Rami Ali
- Division of Cancer Epidemiology, McGill UniversityMontrealCanada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill UniversityMontrealCanada
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill UniversityMontrealCanada
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Le Bihan-Benjamin C, Rocchi M, Putton M, Méric JB, Bousquet PJ. Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France. JAMA Netw Open 2023; 6:e2253204. [PMID: 36701152 PMCID: PMC9880797 DOI: 10.1001/jamanetworkopen.2022.53204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
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Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Mathieu Rocchi
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Maxime Putton
- Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
- Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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Fu R, Sutradhar R, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Dare A, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Hong NJL, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Tinmouth J, Eskander A. Timeliness and Modality of Treatment for New Cancer Diagnoses During the COVID-19 Pandemic in Canada. JAMA Netw Open 2023; 6:e2250394. [PMID: 36626169 PMCID: PMC9856765 DOI: 10.1001/jamanetworkopen.2022.50394] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE The impact of COVID-19 on the modality and timeliness of first-line cancer treatment is unclear yet critical to the planning of subsequent care. OBJECTIVE To explore the association of the COVID-19 pandemic with modalities of and wait times for first cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study using administrative data was conducted in Ontario, Canada, among adults newly diagnosed with cancer between January 3, 2016, and November 7, 2020. Participants were followed up from date of diagnosis for 1 year, until death, or until June 26, 2021, whichever occurred first, to ensure a minimum of 6-month follow-up time. EXPOSURES Receiving a cancer diagnosis in the pandemic vs prepandemic period, using March 15, 2020, the date when elective hospital procedures were halted. MAIN OUTCOMES AND MEASURES The main outcome was a time-to-event variable describing number of days from date of diagnosis to date of receiving first cancer treatment (surgery, chemotherapy, or radiation) or to being censored. For each treatment modality, a multivariable competing-risk regression model was used to assess the association between time to treatment and COVID-19 period. A secondary continuous outcome was defined for patients who were treated 6 months after diagnosis as the waiting time from date of diagnosis to date of treatment. RESULTS Among 313 499 patients, the mean (SD) age was 66.4 (14.1) years and 153 679 (49.0%) were male patients. Those who were diagnosed during the pandemic were less likely to receive surgery first (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99) but were more likely to receive chemotherapy (sHR, 1.26; 95% CI, 1.23-1.30) or radiotherapy (sHR, 1.16; 95% CI, 1.13-1.20) first. Among patients who received treatment within 6 months from diagnosis (228 755 [73.0%]), their mean (SD) waiting time decreased from 35.1 (37.2) days to 29.5 (33.6) days for surgery, from 43.7 (34.1) days to 38.4 (30.6) days for chemotherapy, and from 55.8 (41.8) days to 49.0 (40.1) days for radiotherapy. CONCLUSIONS AND RELEVANCE In this cohort study, the pandemic was significantly associated with greater use of nonsurgical therapy as initial cancer treatment. Wait times were shorter in the pandemic period for those treated within 6 months of diagnosis. Future work needs to examine how these changes may have affected patient outcomes to inform future pandemic guideline development.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Simron Singh
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ambica Parmar
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C. Earle
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ian J. Witterick
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - David R. Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Al-Hussaini M, Al-Ani A, Hammouri M, Al-Huneidy L, Mansour A. Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center. Front Oncol 2023; 13:1088000. [PMID: 36910625 PMCID: PMC9995942 DOI: 10.3389/fonc.2023.1088000] [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: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background There is a paucity of evidence regarding the impact of COVID-19 on cancer care among refugees or patients from areas of conflict. Cancer care for these populations remains fragmented due to resource scarcity and limited infrastructure. Aims To explore the effect of COVID-19 on cancer care among patients from areas of conflict treated at King Hussein Cancer Center (KHCC). Methodology We performed a retrospective chart review of all patients from areas of conflict, treated at KHCC from 2018 to 2021. Patients' demographics and clinical characteristics are presented in the form of descriptive statistics. Interrupted Time Series (ITS) analysis was utilized to investigate the impact of COVID-19 on the number of admissions throughout the study's period. Results A total of 3317 patients from areas of conflict were included in the study. Among these, 1546 were males (46.6%) while 1771 (53.4%) were female. Libyans (34.6%), Palestinians (24.8%), Iraqis (24.5%), Syrians (15.3%), and Sudanese patients (0.9%) constituted our study sample. ITS analysis demonstrated that the start of the COVID-19 lockdown significantly decreased admissions by 44.0% (p = 0.020), while the end of the COVID-19 restriction significantly improved admissions by 43.0% (p = 0.023). Among those with available SEER stages, more than a quarter of patients had distant metastasis (n = 935, 28.2%) irrespective of age and biological sex. Advanced presentations during 2020 had approximately a 16% and 6% increase compared to 2018 and 2019, respectively. Breast cancer (21.4%), hematolymphoid cancers (18.1%), and cancers of the digestive system (16.5%) were the most common cancers among our cohort. Conclusion Restrictions associated with COVID-19 had a significant effect on the number of admissions of patients from areas of conflict. In the long term, this effect may impact the survival outcomes of affected patients.
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Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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Cao Y, Fabre V, Anderson R, Bova G, Souranis AN, Briner V, Kleinberg LR, Han-Oh S, Wright JL, Viswanathan AN. From Alpha to Omicron: A Radiation Oncology Network's Biocontainment-Based COVID-19 Experience. Adv Radiat Oncol 2023; 8:101094. [PMID: 36311821 PMCID: PMC9597568 DOI: 10.1016/j.adro.2022.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/27/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To develop the safest possible environment for treating urgent patients with COVID-19 requiring radiation, we describe the unique construction of negative air pressure computed tomography simulator and linear accelerator treatment vaults in addition to screening, delay, and treatment protocols and their evolution over the course of the COVID-19 pandemic. Methods and Materials Construction of large high-efficiency particulate air filter air-flow systems into existing ductwork in computed tomography simulator rooms and photon and proton treatment vaults was completed to create negative-pressure rooms. An asymptomatic COVID-19 screening protocol was implemented for all patients before initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from June 2020 to January 2022 were retrospectively reviewed. Results Negative air-flow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from June 2020 through January 2022 across 5 separate centers. The majority of patients with COVID-19 had radiation treatment deferred when deemed safe. A total of 42 patients with COVID-19, who were at highest risk of an adverse outcome should there be a radiation delay, were treated under the COVID-19 biocontainment protocol in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority of patients (64.3%) were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range, 1-15) before COVID-19 clearance and resumption of treatment in a normal air-flow environment. Conclusions Constructing negative-pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of urgent radiation oncology patients with COVID-19 within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
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Affiliation(s)
- Yilin Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valeria Fabre
- Department of Medicine – Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Roberta Anderson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory Bova
- Johns Hopkins Health System, Baltimore, Maryland
| | - Annette N. Souranis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie Briner
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean L. Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland,Corresponding author: Akila N. Viswanathan, MD, MPH
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Effects of the
COVID
‐19 pandemic on gastroenterological surgeries in 2020: A study using the National Clinical Database of Japan. Ann Gastroenterol Surg 2022; 7:407-418. [PMID: 37152784 PMCID: PMC10154870 DOI: 10.1002/ags3.12638] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Aim This study aimed to investigate the effect of the coronavirus disease pandemic on the number of surgeries for gastroenterological cancer cases in Japan. Methods The data recorded in the National Clinical Database of Japan between 2018 and 2020 were utilized for this study. Five specific surgeries for primary cancers and surgery for acute diffuse peritonitis were considered the primary endpoints. We divided the study period into the prepandemic and postpandemic (after April 2020) periods and examined the number of surgeries in relation to clinical factors. Results Overall, 228 860 surgeries were analyzed. Among the five primary cancer surgeries, the number of distal gastrectomies for gastric cancer decreased the most (to 81.0% of the monthly number in the prepandemic period), followed by that of low anterior resections for rectal cancer (91.4%). In contrast, the number of pancreaticoduodenectomies for pancreatic cancer increased by 7.1%, while that of surgeries for peritonitis remained stable. This trend was observed nationwide. We also noted a marked reduction in the number of distal gastrectomy (to 72.5%), low anterior resection (84.0%), and esophagectomy (88.8%) procedures for T1 tumors. The noncurative resection rate and mortalities were low despite the increased proportion of T4 tumors and older patients. Conclusion A marked reduction in surgeries for gastric and rectal cancers with early T factors may reflect prioritization of surgeries and reduction in cancer screenings. Although the quality of the surgery was maintained in terms of reduced mortalities and morbidities, the long-term effects of this pandemic should be monitored.
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Fu R, Sutradhar R, Dare A, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Look Hong NJ, Eskander A. Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic? Curr Oncol 2022; 29:7732-7744. [PMID: 36290888 PMCID: PMC9600641 DOI: 10.3390/curroncol29100611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02-1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04-1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06-1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Anna Dare
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Qing Li
- ICES, Toronto, ON M4N 3M5, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON K7L 3N6, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, ON M5G 0A3, Canada
| | - Kelvin K. W. Chan
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 1X5, Canada
| | - Natalie Coburn
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Julie Hallet
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ambica Parmar
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Craig C. Earle
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Antonio Finelli
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - David R. Urbach
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Surgery, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Danny Enepekides
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Antoine Eskander
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Correspondence: ; Tel.: +1-416-480-6705
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Habbous S, Tai X, Beca JM, Arias J, Raphael MJ, Parmar A, Crespo A, Cheung MC, Eisen A, Eskander A, Singh S, Trudeau M, Gavura S, Dai WF, Irish J, Krzyzanowska M, Lapointe-Shaw L, Naipaul R, Peacock S, Yeung L, Forbes L, Chan KKW. Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada. JAMA Netw Open 2022; 5:e2225118. [PMID: 35917122 PMCID: PMC9346546 DOI: 10.1001/jamanetworkopen.2022.25118] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE In response to an increase in COVID-19 infection rates in Ontario, several systemic treatment (ST) regimens delivered in the adjuvant setting for breast cancer were temporarily permitted for neoadjuvant-intent to defer nonurgent breast cancer surgical procedures. OBJECTIVE To examine the use and compare short-term outcomes of neoadjuvant-intent vs adjuvant ST in the COVID-19 era compared with the pre-COVID-19 era. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada. Patients with cancer starting selected ST regimens in the COVID-19 era (March 11, 2020, to September 30, 2020) were compared to those in the pre-COVID-19 era (March 11, 2019, to March 10, 2020). Patients were diagnosed with breast cancer within 6 months of starting systemic therapy. MAIN OUTCOMES AND MEASURES Estimates were calculated for the use of neoadjuvant vs adjuvant ST, the likelihood of receiving a surgical procedure, the rate of emergency department visits, hospital admissions, COVID-19 infections, and all-cause mortality between treatment groups over time. RESULTS Among a total of 10 920 patients included, 7990 (73.2%) started treatment in the pre-COVID-19 era and 7344 (67.3%) received adjuvant ST; the mean (SD) age was 61.6 (13.1) years. Neoadjuvant-intent ST was more common in the COVID-19 era (1404 of 2930 patients [47.9%]) than the pre-COVID-19 era (2172 of 7990 patients [27.2%]), with an odds ratio of 2.46 (95% CI, 2.26-2.69; P < .001). This trend was consistent across a range of ST regimens, but differed according to patient age and geography. The likelihood of receiving surgery following neoadjuvant-intent chemotherapy was similar in the COVID-19 era compared with the pre-COVID-19 era (log-rank P = .06). However, patients with breast cancer receiving neoadjuvant-intent hormonal therapy were significantly more likely to receive surgery in the COVID-19 era (log-rank P < .001). After adjustment, there were no significant changes in the rate of emergency department visits over time between patients receiving neoadjuvant ST, adjuvant ST, or ST only during the ST treatment period or postoperative period. Hospital admissions decreased in the COVID-19 era for patients who received neoadjuvant ST compared with adjuvant ST or ST alone (P for interaction = .01 for both) in either setting. CONCLUSIONS AND RELEVANCE In this cohort study, patients were more likely to start neoadjuvant ST in the COVID-19 era, which varied across the province and by indication. There was limited evidence to suggest any substantial impact on short-term outcomes.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Xiaochen Tai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jaclyn M Beca
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jessica Arias
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michael J. Raphael
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Crespo
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Matthew C Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jonathan Irish
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rohini Naipaul
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Lyndee Yeung
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, RS McLaughlin Durham Regional Cancer Centre Lakeridge Health, Oshawa, Ontario, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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