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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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2
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Sriprasart T, Siasoco MB, Aggarwal B, Levy G, Phansalkar A, Van GV, Cohen M, Seemungal T, Pizzichini MMM, Mokhtar M, Daley-Yates P. The role of modeling studies in asthma management and clinical decision-making: a Delphi survey of physician knowledge and perceptions. J Asthma 2023:1-15. [PMID: 36825839 DOI: 10.1080/02770903.2023.2180748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To investigate the knowledge and perceptions of physicians on the role of modeling studies in asthma, using a modified Delphi procedure. METHODS Group opinions among a panel of respiratory experts were obtained using two online questionnaires and a virtual scientific workshop. A consensus was pre-defined as agreement by >75% of participants. RESULTS From 26 experts who agreed to participate, 22 completed both surveys. At the end of the process, the panel rated their own understanding of modeling as good (77%) but that among physicians in general as poor (77%). Participants agreed that data from modeling studies should be used, at least sometimes, to inform treatment guidelines (91%) and could be useful for guiding clinical decisions (100%). Perceived barriers to using modeling studies were 'A lack of understanding' (81%) and 'A lack of standardized methodology' (82%). Based on data from two modeling studies, no consensus was reached on physicians recommending regular inhaled corticosteroids (ICS) versus as-needed therapy for patients with mild asthma, whereas 77% agreed that they would recommend regular ICS over maintenance and reliever therapy for ≥80% of their patients with moderate asthma. No consensus was reached on the value of modeling data in relation to empirical data. CONCLUSION There is overall support among respiratory experts for the usefulness of modeling data to guide asthma treatment guidelines and clinical decision making. More publications on modeling data using robust models and accessible terminology will aid the understanding of physicians in general and help clarify the evidence-based value of modeling studies.
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Affiliation(s)
- Thitiwat Sriprasart
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ma Bella Siasoco
- Pulmonary Division, Department of Medicine, University of the Philippines College of Medicine - Philippine General Hospital, Manila, Philippines
| | | | - Gur Levy
- Respiratory Medical Emerging Markets, GSK, Ciudad de Panamá, Panama
| | | | - Giap Vu Van
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam.,Internal Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | - Mark Cohen
- Edificio Clinicas Centro Médico 2, Guatemala city, Guatemala
| | - Terence Seemungal
- Faculty of Medical Sciences, The University of The West Indies, St. Augustine, Trinidad & Tobago
| | - Marcia M M Pizzichini
- Internal Medicine Division, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Mahmoud Mokhtar
- Respiratory Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Yong JHE, Nadeau C, Flanagan WM, Coldman AJ, Asakawa K, Garner R, Fitzgerald N, Yaffe MJ, Miller AB. The OncoSim-Breast Cancer Microsimulation Model. Curr Oncol 2022; 29:1619-1633. [PMID: 35323336 PMCID: PMC8947518 DOI: 10.3390/curroncol29030136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023] Open
Abstract
Background: OncoSim-Breast is a Canadian breast cancer simulation model to evaluate breast cancer interventions. This paper aims to describe the OncoSim-Breast model and how well it reproduces observed breast cancer trends. Methods: The OncoSim-Breast model simulates the onset, growth, and spread of invasive and ductal carcinoma in situ tumours. It combines Canadian cancer incidence, mortality, screening program, and cost data to project population-level outcomes. Users can change the model input to answer specific questions. Here, we compared its projections with observed data. First, we compared the model’s projected breast cancer trends with the observed data in the Canadian Cancer Registry and from Vital Statistics. Next, we replicated a screening trial to compare the model’s projections with the trial’s observed screening effects. Results: OncoSim-Breast’s projected incidence, mortality, and stage distribution of breast cancer were close to the observed data in the Canadian Cancer Registry and from Vital Statistics. OncoSim-Breast also reproduced the breast cancer screening effects observed in the UK Age trial. Conclusions: OncoSim-Breast’s ability to reproduce the observed population-level breast cancer trends and the screening effects in a randomized trial increases the confidence of using its results to inform policy decisions related to early detection of breast cancer.
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Affiliation(s)
- Jean H. E. Yong
- Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Correspondence:
| | - Claude Nadeau
- Statistics Canada, Ottawa, ON K1A 0T6, Canada; (C.N.); (W.M.F.); (K.A.); (R.G.)
| | - William M. Flanagan
- Statistics Canada, Ottawa, ON K1A 0T6, Canada; (C.N.); (W.M.F.); (K.A.); (R.G.)
| | - Andrew J. Coldman
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada;
| | - Keiko Asakawa
- Statistics Canada, Ottawa, ON K1A 0T6, Canada; (C.N.); (W.M.F.); (K.A.); (R.G.)
| | - Rochelle Garner
- Statistics Canada, Ottawa, ON K1A 0T6, Canada; (C.N.); (W.M.F.); (K.A.); (R.G.)
| | | | | | - Anthony B. Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
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4
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van Wifferen F, de Jonge L, Worthington J, Greuter MJ, Lew JB, Nadeau C, van den Puttelaar R, Feletto E, Yong JH, Lansdorp-Vogelaar I, Canfell K, Coupé VM, Anderson L, Besó Delgado M, Binefa G, Cust A, Dekker E, Dell’Anna V, Essue B, Espinas J, Flander L, Garcia M, Hahn A, Idigoras I, Katanoda K, Laghi L, Lamrock F, McFerran E, Majek O, Molina-Barceló A, Ledger M, Musa O, Njor S, O’Connor K, Portillo I, Salas D, Senore C, Smith H, Symonds E, Tachecí I, Taksler G, Tolani M, Treby M, Zauber A, Zheng Y. Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study. J Med Screen 2021; 29:72-83. [PMID: 35100894 PMCID: PMC9087314 DOI: 10.1177/09691413211056777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has
been disrupted in many countries during the COVID-19 pandemic. Performing
catch-up of missed screens while maintaining regular screening services
requires additional colonoscopy capacity that may not be available. This
study aimed to compare strategies that clear the screening backlog using
limited colonoscopy resources. Methods A range of strategies were simulated using four country-specific CRC
natural-history models: Adenoma and Serrated pathway to Colorectal CAncer
(ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both
in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada).
Strategies assumed a 3-month screening disruption with varying recovery
period lengths (6, 12, and 24 months) and varying FIT thresholds for
diagnostic colonoscopy. Increasing the FIT threshold reduces the number of
referrals to diagnostic colonoscopy. Outcomes for each strategy were
colonoscopy demand and excess CRC-related deaths due to the disruption. Results Performing catch-up using the regular FIT threshold in 6, 12 and 24 months
could prevent most excess CRC-related deaths, but required 50%, 25% and
12.5% additional colonoscopy demand, respectively. Without exceeding usual
colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented
by increasing the FIT threshold for 12 or 24 months. Large increases in FIT
threshold could lead to additional deaths rather than preventing them. Conclusions Clearing the screening backlog in 24 months could avert most excess
CRC-related deaths due to a 3-month disruption but would require a small
increase in colonoscopy demand. Increasing the FIT threshold slightly over
24 months could ease the pressure on colonoscopy resources.
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Affiliation(s)
- Francine van Wifferen
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - Marjolein J.E. Greuter
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - Claude Nadeau
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | | | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | | | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Veerle M.H. Coupé
- Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
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5
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Yong JHE, Mainprize JG, Yaffe MJ, Ruan Y, Poirier AE, Coldman A, Nadeau C, Iragorri N, Hilsden RJ, Brenner DR. The impact of episodic screening interruption: COVID-19 and population-based cancer screening in Canada. J Med Screen 2021; 28:100-107. [PMID: 33241760 PMCID: PMC7691762 DOI: 10.1177/0969141320974711] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/05/2022]
Abstract
BACKGROUND Population-based cancer screening can reduce cancer burden but was interrupted temporarily due to the COVID-19 pandemic. We estimated the long-term clinical impact of breast and colorectal cancer screening interruptions in Canada using a validated mathematical model. METHODS We used the OncoSim breast and colorectal cancers microsimulation models to explore scenarios of primary screening stops for 3, 6, and 12 months followed by 6-24-month transition periods of reduced screening volumes. For breast cancer, we estimated changes in cancer incidence over time, additional advanced-stage cases diagnosed, and excess cancer deaths in 2020-2029. For colorectal cancer, we estimated changes in cancer incidence over time, undiagnosed advanced adenomas and colorectal cancers in 2020, and lifetime excess cancer incidence and deaths. RESULTS Our simulations projected a surge of cancer cases when screening resumes. For breast cancer screening, a three-month interruption could increase cases diagnosed at advanced stages (310 more) and cancer deaths (110 more) in 2020-2029. A six-month interruption could lead to 670 extra advanced cancers and 250 additional cancer deaths. For colorectal cancers, a six-month suspension of primary screening could increase cancer incidence by 2200 cases with 960 more cancer deaths over the lifetime. Longer interruptions, and reduced volumes when screening resumes, would further increase excess cancer deaths. CONCLUSIONS Interruptions in cancer screening will lead to additional cancer deaths, additional advanced cancers diagnosed, and a surge in demand for downstream resources when screening resumes. An effective strategy is needed to minimize potential harm to people who missed their screening.
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Affiliation(s)
| | | | - Martin J Yaffe
- Sunnybrook Research Institute, Toronto, Canada
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | | | | | | | - Robert J Hilsden
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Canada
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Pader J, Ruan Y, Poirier AE, Asakawa K, Lu C, Memon S, Miller A, Walter S, Villeneuve PJ, King WD, Volesky KD, Smith L, De P, Friedenreich CM, Brenner DR. Estimates of future cancer mortality attributable to modifiable risk factors in Canada. Canadian Journal of Public Health 2021; 112:1069-1082. [PMID: 34036522 DOI: 10.17269/s41997-020-00455-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Modifiable lifestyle, environmental, and infectious risk factors associated with cancer impact both cancer incidence and mortality at the population level. Most studies estimating this burden focus on cancer incidence. However, because these risk factors are associated with cancers of disparate mortality rates, the burden associated with cancer incidence could differ from cancer mortality. Therefore, estimating the cancer mortality attributable to these risk factors provides additional insight into cancer prevention. Here, we estimated future cancer deaths and the number of avoidable deaths in Canada due to modifiable risk factors. METHODS The projected cancer mortality data came from OncoSim, a web-based microsimulation tool. These data were applied to the methodological framework that we previously used to estimate the population attributable risks and the potential impact fractions of modifiable risk factors on Canadian cancer incidence. RESULTS We estimated that most cancer deaths will be attributed to tobacco smoking with an average of 27,900 deaths annually from 2024 to 2047. If Canada's current trends in excess body weight continue, cancer deaths attributable to excess body weight would double from 2786 deaths in 2024 to 5604 deaths in 2047, becoming the second leading modifiable cause of cancer death. Applying targets to reduce these risk factors, up to 34,600 cancer deaths could be prevented from 2024 to 2047. CONCLUSION Our simulated results complement our previous findings on the cancer incidence burden since decreasing the overall burden of cancer will be accelerated through a combination of decreasing cancer incidence and improving survival outcomes through improved treatments.
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Affiliation(s)
- Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Room 513C, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Room 513C, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Room 513C, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada
| | - Keiko Asakawa
- Statistics Canada, Government of Canada, Ottawa, Ontario, Canada
| | - Chaohui Lu
- Statistics Canada, Government of Canada, Ottawa, Ontario, Canada
| | - Saima Memon
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Anthony Miller
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paul J Villeneuve
- School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Karena D Volesky
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Leah Smith
- Canadian Cancer Society, Toronto, Ontario, Canada
| | | | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Room 513C, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Room 513C, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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7
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Smith HA, Yong JHE, Kandola K, Boushey R, Kuziemsky C. Participatory simulation modeling to inform colorectal cancer screening in a complex remote northern health system: Canada's Northwest Territories. Int J Med Inform 2021; 150:104455. [PMID: 33857774 DOI: 10.1016/j.ijmedinf.2021.104455] [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: 09/22/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) mortality in the Northwest Territories (NWT), a northern region of Canada, could be reduced by implementing a CRC screening program. However, this may require additional colonoscopy resources. We used participatory simulation modeling to predict colonoscopy demand and to develop strategies for implementing a feasible and effective CRC screening program in this complex remote northern health system. METHODS Using a participatory simulation modeling approach, we first developed a conceptual model of CRC screening with local collaborators. This approach informed our parameter adjustments of an existing microsimulation model, OncoSim-CRC, using data from a retrospective cohort review of CRC screening between 2014-2019 and secondary data. Model scenarios reflecting program implementation were run for 500 million cases. Validity was assessed, and outputs analyzed with collaborators. Alternative scenarios were developed to reduce colonoscopy demand and results were presented to end-users. RESULTS We estimated that colonoscopy demand with a CRC screening program phased-in over 5 years would surpass capacity within 2 years. If demand is met, screen-detected cancers would increase by 110 %, and clinically-detected cases would reduce by 26 % over the next 30 years. We also found that prolonging the phase-in period, or revising adenoma follow-up guidelines would reduce colonoscopy demand while still improving cancer detection. Both strategies were considered feasible by collaborators. The adjusted model was valid, and the projections informed local end-users plans for CRC screening delivery. CONCLUSIONS Using participatory simulation modeling, we projected that a screening program would improve CRC detection but surpass current colonoscopy capacity. Phasing-in the screening program and reducing endoscopic adenoma follow-up would enhance feasibility of a CRC screening program in the NWT and help maintain its effectiveness.
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Affiliation(s)
- Heather Anne Smith
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada; Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.
| | | | - Kami Kandola
- Office of the Chief Public Health Officer, Department of Health and Social Services, Yellowknife, NWT, Canada
| | - Robin Boushey
- Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, AB, Canada
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8
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de Jonge L, Worthington J, van Wifferen F, Iragorri N, Peterse EFP, Lew JB, Greuter MJE, Smith HA, Feletto E, Yong JHE, Canfell K, Coupé VMH, Lansdorp-Vogelaar I. Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study. Lancet Gastroenterol Hepatol 2021; 6:304-314. [PMID: 33548185 PMCID: PMC9767453 DOI: 10.1016/s2468-1253(21)00003-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and mortality in three countries using microsimulation modelling. METHODS In this modelling study, we used four country-specific colorectal cancer microsimulation models-Policy1-Bowel (Australia), OncoSim (Canada), and ASCCA and MISCAN-Colon (the Netherlands)-to estimate the potential impact of COVID-19-related disruptions to screening on colorectal cancer incidence and mortality in Australia, Canada, and the Netherlands annually for the period 2020-24 and cumulatively for the period 2020-50. Modelled scenarios varied by duration of disruption (3, 6, and 12 months), decreases in screening participation after the period of disruption (0%, 25%, or 50% reduction), and catch-up screening strategies (within 6 months after the disruption period or all screening delayed by 6 months). FINDINGS Without catch-up screening, our analysis predicted that colorectal cancer deaths among individuals aged 50 years and older, a 3-month disruption would result in 414-902 additional new colorectal cancer diagnoses (relative increase 0·1-0·2%) and 324-440 additional deaths (relative increase 0·2-0·3%) in the Netherlands, 1672 additional diagnoses (relative increase 0·3%) and 979 additional deaths (relative increase 0·5%) in Australia, and 1671 additional diagnoses (relative increase 0·2%) and 799 additional deaths (relative increase 0·3%) in Canada between 2020 and 2050, compared with undisrupted screening. A 6-month disruption would result in 803-1803 additional diagnoses (relative increase 0·2-0·4%) and 678-881 additional deaths (relative increase 0·4-0·6%) in the Netherlands, 3552 additional diagnoses (relative increase 0·6%) and 1961 additional deaths (relative increase 1·0%) in Australia, and 2844 additional diagnoses (relative increase 0·3%) and 1319 additional deaths (relative increase 0·4%) in Canada between 2020 and 2050, compared with undisrupted screening. A 12-month disruption would result in 1619-3615 additional diagnoses (relative increase 0·4-0·9%) and 1360-1762 additional deaths (relative increase 0·8-1·2%) in the Netherlands, 7140 additional diagnoses (relative increase 1·2%) and 3968 additional deaths (relative increase 2·0%) in Australia, and 5212 additional diagnoses (relative increase 0·6%) and 2366 additional deaths (relative increase 0·8%) in Canada between 2020 and 2050, compared with undisrupted screening. Providing immediate catch-up screening could minimise the impact of the disruption, restricting the relative increase in colorectal cancer incidence and deaths between 2020 and 2050 to less than 0·1% in all countries. A post-disruption decrease in participation could increase colorectal cancer incidence by 0·2-0·9% and deaths by 0·6-1·6% between 2020 and 2050, compared with undisrupted screening. INTERPRETATION Although the projected effect of short-term disruption to colorectal cancer screening is modest, such disruption will have a marked impact on colorectal cancer incidence and deaths between 2020 and 2050 attributable to missed screening. Thus, it is crucial that, if disrupted, screening programmes ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, since this could mitigate the impact on colorectal cancer deaths. FUNDING Cancer Council New South Wales, Health Canada, and Dutch National Institute for Public Health and Environment.
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Affiliation(s)
- Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands,Correspondence to: Ms Lucie de Jonge, Department of Public Health, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Joachim Worthington
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Francine van Wifferen
- Department of Epidemiology and Data Science, Decision Modelling Center, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Nicolas Iragorri
- Canadian Partnership against Cancer, Toronto, ON, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Elisabeth F P Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Marjolein J E Greuter
- Department of Epidemiology and Data Science, Decision Modelling Center, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Heather A Smith
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jean H E Yong
- Canadian Partnership against Cancer, Toronto, ON, Canada
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia,School of Public Health, The University of Sydney, Sydney, NSW, Australia,University of New South Wales, Sydney, NSW, Australia
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Decision Modelling Center, Amsterdam University Medical Center, Amsterdam, Netherlands
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