1
|
Halpern MT, Liu B, Lowy DR, Gupta S, Croswell JM, Doria-Rose VP. The Annual Cost of Cancer Screening in the United States. Ann Intern Med 2024; 177:1170-1178. [PMID: 39102723 DOI: 10.7326/m24-0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. OBJECTIVE To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. DESIGN Model using national health care survey and cost resources data. SETTING U.S. health care systems and institutions. PARTICIPANTS People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. MEASUREMENTS The number of people screened and associated health care system costs by insurance status in 2021 dollars. RESULTS Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. LIMITATIONS All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. CONCLUSION The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. PRIMARY FUNDING SOURCE None.
Collapse
Affiliation(s)
- Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Douglas R Lowy
- Office of the Director, National Cancer Institute, Bethesda, Maryland (D.R.L.)
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego, California, and UC San Diego Division of Gastroenterology and Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California (S.G.)
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| |
Collapse
|
2
|
Manzella A, Ecker BL, Eskander MF, Grandhi MS, In H, Kravchenko T, Langan RC, Kennedy T, Alexander HR, Beninato T, Pitt HA. Operative trends for pancreatic and hepatic malignancies during the COVID-19 pandemic. Surgery 2024; 176:364-370. [PMID: 38582733 DOI: 10.1016/j.surg.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic. METHODS Adult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods. RESULTS A total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P = .257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P = .002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P = .169 and P = .598). CONCLUSION Pancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic.
Collapse
Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brett L Ecker
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Mariam F Eskander
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Miral S Grandhi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Haejin In
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Timothy Kravchenko
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Russell C Langan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Timothy Kennedy
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - H Richard Alexander
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Henry A Pitt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| |
Collapse
|
3
|
Bowers JM, Huelsnitz CO, Dwyer LA, Gibson LP, Agurs-Collins T, Ferrer RA, Acevedo AM. Measuring Relationship Influences on Romantic Couples' Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors. JMIR Res Protoc 2024; 13:e48516. [PMID: 39083795 PMCID: PMC11325112 DOI: 10.2196/48516] [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: 06/01/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Research has established the effects of romantic relationships on individuals' morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. OBJECTIVE We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners' engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. METHODS The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. RESULTS Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. CONCLUSIONS We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48516.
Collapse
Affiliation(s)
- Jennifer M Bowers
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Chloe O Huelsnitz
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Laura A Dwyer
- Cape Fox Facilities Services, Manassas, VA, United States
| | - Laurel P Gibson
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Tanya Agurs-Collins
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Rebecca A Ferrer
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Amanda M Acevedo
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| |
Collapse
|
4
|
Lee ML, Megwalu UC, Finegersh A, Noel JE, Chen MM. Impact of the COVID-19 Pandemic on Thyroid Cancer Surgery. Curr Oncol 2024; 31:3579-3590. [PMID: 38920746 PMCID: PMC11202414 DOI: 10.3390/curroncol31060263] [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: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
The COVID-19 pandemic caused major disruptions to healthcare services in 2020, delaying cancer diagnosis and treatment. While early-stage thyroid cancer often progresses slowly, it is crucial to determine whether treatment delays associated with the pandemic have impacted the clinical presentation and management of advanced-stage thyroid cancer. The purpose of our study was to determine the impact of the early COVID-19 pandemic on thyroid cancer presentation and treatment times. Utilizing the National Cancer Database, chi-squared tests and regression analyses were performed to compare patient demographic and clinical characteristics over time for 56,011 patients diagnosed with primary thyroid cancer who were treated at the Commission on Cancer-accredited sites in 2019 and 2020. We found that thyroid cancer diagnoses decreased between 2019 and 2020, with the biggest drop among patients with cT1 disease relative to other T stages. We also found that patients diagnosed with thyroid cancer in 2020 had similar treatment times to patients diagnosed in 2019, as measured by both the time between diagnosis and start of treatment and the time between surgery and start of radioactive iodine therapy. Overall, our study suggests that resources during the pandemic were allocated to patients with advanced thyroid disease, despite a decrease in diagnoses.
Collapse
Affiliation(s)
- Max L. Lee
- Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Uchechukwu C. Megwalu
- Department of Otolaryngology--Head & Neck Surgery, Stanford University, Palo Alto, CA 94304, USA; (U.C.M.); (A.F.); (J.E.N.)
| | - Andrey Finegersh
- Department of Otolaryngology--Head & Neck Surgery, Stanford University, Palo Alto, CA 94304, USA; (U.C.M.); (A.F.); (J.E.N.)
| | - Julia E. Noel
- Department of Otolaryngology--Head & Neck Surgery, Stanford University, Palo Alto, CA 94304, USA; (U.C.M.); (A.F.); (J.E.N.)
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | - Michelle M. Chen
- Department of Otolaryngology--Head & Neck Surgery, Stanford University, Palo Alto, CA 94304, USA; (U.C.M.); (A.F.); (J.E.N.)
- ValleyCare Pleasanton Cancer Center, Pleasanton, CA 94588, USA
| |
Collapse
|
5
|
Trojanowski M, Radomyski P, Kycler W, Michalek IM. The impact of the COVID-19 pandemic on incidence gap in screen-detectable cancers: a cohort study in Greater Poland, Poland. Rep Pract Oncol Radiother 2024; 29:131-140. [PMID: 39143965 PMCID: PMC11321766 DOI: 10.5603/rpor.99354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/05/2024] [Indexed: 08/16/2024] Open
Abstract
Background The global COVID-19 pandemic has had a significant impact on healthcare systems. This study aimed to assess the incidence gap in screening-detectable cancers in the Greater Poland (Poland) in 2020. Materials and methods Data on breast, cervix uteri, and colorectal cancer cases diagnosed from 2010 to 2020 were obtained from the regional cancer registry. Standardized incidence ratios (SIR) and incidence rate differences (IRD) were calculated to estimate the change in incident cancer cases during the pandemic. The number of observed cases was extracted from the registry database. Simple linear regression analysis was used to predict the expected number of incident cancer cases in 2020 and the age-standardized incidence rate based on registry data from the preceding ten years (2010-2019). Results In 2020, the registered number of incident female breast cancer cases decreased by 12% [SIR 0.88, 95% confidence interval (CI): 0.88-0.92, observed: 1,848, expected: 2,101], resulting in an IRD of -6.3 per 100 K. The number of registered cervical cancers decreased by 15% (SIR 0.85, 95% CI: 0.73-0.98, observed: 181, expected: 213), with an IRD of -0.8 per 100 K. For colorectal cancer, there was a 16% decrease in new cases among females (SIR 0.84, 95% CI: 0.78-0.90) and a 15% decrease among males (SIR 0.85, 95% CI: 0.80-0.91), resulting in IRDs of -3.04 and -5.29 per 100K, respectively. Conclusions The COVID-19 pandemic led to a significant, 15% decrease in newly diagnosed screening-detectable cancer cases in 2020. Further studies are needed to investigate the impact of delayed cancer diagnoses on stage at diagnosis and survival rates.
Collapse
Affiliation(s)
- Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Radomyski
- Radiology Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Witold Kycler
- Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Irmina Maria Michalek
- Department of Cancer Pathology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| |
Collapse
|
6
|
Robles C, Monfil L, Ibáñez R, Roura E, Font R, Peremiquel-Trillas P, Brotons M, Martínez-Bueno C, de Sanjosé S, Espinàs JA, Bruni L. Impact of the COVID-19 pandemic on cervical cancer screening participation, abnormal cytology prevalence and screening interval in Catalonia. Front Oncol 2024; 14:1338859. [PMID: 38873256 PMCID: PMC11171128 DOI: 10.3389/fonc.2024.1338859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Background The COVID-19 pandemic led to a national lockdown and the interruption of all cancer preventive services, including cervical cancer screening. We aimed to assess the COVID-19 pandemic impact on opportunistic screening participation, abnormal cytology (ASCUS+) prevalence and screening interval in 2020 and 2021 within the Public Health System of Catalonia, Spain. Methods Individual data on cytology and HPV testing of women aged 25-65 from 2014 to 2021 were retrieved from the Information System for Primary Care Services (SISAP). Time-series regression models were used to estimate expected screening participation and abnormal cytology prevalence in 2020 and 2021. The impact was determined by comparing observed and expected values (ratios). Additionally, changes in screening interval trends between 2014 and 2021 were assessed by fitting a Piecewise linear regression model. Results Cervical cancer screening participation decreased by 38.8% and 2.2% in 2020 and 2021, respectively, with the most significant impact on participation (-96.1%) occurring in April 2020. Among older women, participation was lower, and it took longer to recover. Abnormal cytology prevalence was 1.4 times higher than expected in 2020 and 2021, with variations by age (range=1.1-1.5). From June 2020 onwards, the screening interval trend significantly changed from an increase of 0.59 to 3.57 months per year, resulting in a median time of 48 months by December 2021. Conclusions During the pandemic, fewer women have participated in cervical cancer screening, abnormal cytology prevalence has increased, and the screening interval is more prolonged than before. The potential cervical cancer lifetime risk implications highlight the need for organized HPV-based screening.
Collapse
Affiliation(s)
- Claudia Robles
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Monfil
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Ibáñez
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Esther Roura
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Rebeca Font
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain
| | - Paula Peremiquel-Trillas
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Maria Brotons
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| | - Cristina Martínez-Bueno
- University of Barcelona, Barcelona, Spain
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Catalunya, Institut Català de la Salut, Barcelona, Spain
- Grup de Recerca en Salut Sexual i Reproductiva (GRASSIR), Barcelona, Spain
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Institut de Salut Global (ISGlobal), Barcelona, Spain
| | | | - Laia Bruni
- Unit of Infections and Cancer – Information and Interventions, Cancer Epidemiology Research Programme, Institut Català d’Oncologia (ICO), Infections and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP - CB06/02/0073), Madrid, Spain
| |
Collapse
|
7
|
Rahimi AO, Hsu CH, Soliman D, Maegawa FB, Ghaderi I. The impact of COVID-19 pandemic on patient selection and access to care, approach type, and postoperative outcomes in bariatric surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00639-7. [PMID: 38955647 DOI: 10.1016/j.soard.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic had affected the health systems across the world since early 2020 with a concern about access to medical care during the first wave of COVID-19 pandemic. OBJECTIVES The objective of this study was to examine how the COVID-19 pandemic influenced patient selection, approach type, and postoperative outcomes in elective bariatric surgery. SETTING United States. METHODS Data from the MBSAQIP database for the years 2016-2020 were queried. Wilcoxon rank-sum test and Fisher's exact test were employed for continuous and categorical variables, respectively. Postoperative outcomes within 30 days were assessed separately and based on the Clavien-Dindo (CD) classification of III-V. χ2 test and logistic regression were used to compare outcomes between procedure and approach types, as well as surgical operation periods. RESULTS A total of 741,620 patients underwent robotic and laparoscopic sleeve gastrectomy and Roux-en-Y gastric-bypass. The cases performed in 2020 exhibited lower comorbidities and postoperative complications compared to prepandemic years, regardless of the approach type. Notably, the proportion of White patients decreased during the pandemic, while there was an increase in the number of African American and Hispanic patients who had bariatric surgery. CONCLUSIONS Patients who underwent bariatric surgery during the COVID-19 pandemic appeared to be healthier with fewer comorbidities and experienced fewer adverse postoperative outcomes compared to those who had surgery prior to the pandemic. This study highlights the limited access to bariatric surgery for high-risk patients during the pandemic.
Collapse
Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Felipe B Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, Georgia
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
| |
Collapse
|
8
|
Bennett D, Murray I, Mitchell H, Gavin A, Donnelly D. Impact of COVID-19 on cancer incidence, presentation, diagnosis, treatment and survival in Northern Ireland. Int J Cancer 2024; 154:1731-1744. [PMID: 38268160 DOI: 10.1002/ijc.34847] [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: 10/23/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
The COVID-19 pandemic had a major impact on cancer patients and services but has been difficult to quantify. We examined how the entire cancer pathway-from incidence, presentation, diagnosis, stage, treatment and survival-was affected in Northern Ireland during April-December 2020 compared to equivalent 2018-2019 periods using retrospective, observational cancer registry data from the Northern Ireland Cancer Registry (NICR). There were 6748 cancer cases in April-December 2020 and an average 7724 patients in April-December 2018-2019. Incident cases decreased by 13% (almost 1000). Significant differences were found across age cohorts and deprivation quintiles, with reductions greatest for younger people (<55 years; 19% decrease) and less deprived (22% decrease). A higher proportion had emergency admission (16%-to-20%) with lower proportions diagnosed pathologically (85%-to-83%). There was a significant stage shift, with lower proportions of early stage (29%-to-25%) and higher late-stage (21%-to-23%). Lower proportions received surgery (41%-to-38%) and radiotherapy (24%-to-22%) with a higher proportion not receiving treatment (29%-to-33%). One-year observed-survival decreased from 73.7% to 69.8% and 1-year net-survival decreased from 76.1% to 72.9%, with differences driven by five tumours; Lung (40.3%-to-35.0%), Head-and-Neck (77.4%-to-68.4%), Oesophageal (53.5%-to-42.3%), Lymphoma (81.1%-to-75.2%) and Uterine cancer (87.4%-to-80.4%). Our study reveals profound adverse impact of COVID-19 on the entire cancer patient pathway, with 13% fewer cases, greater emergency admissions and significant stage-shift from early to more advanced-stage disease. There was major treatment impact with lower rates of surgery and radiotherapy and higher proportions receiving no treatment. There were significant reductions in 1-year survival. Our study will support service recovery and protect cancer services in future pandemics or disruptions.
Collapse
Affiliation(s)
- Damien Bennett
- Northern Ireland Cancer Registry, Centre for Public Health, Belfast, Northern Ireland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Inez Murray
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Helen Mitchell
- Northern Ireland Cancer Registry, Centre for Public Health, Belfast, Northern Ireland
| | - Anna Gavin
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - David Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Belfast, Northern Ireland
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Madu CT, Lee TF, Sohn A, Hu J, Matayev R, Paranjpe V, Fam J, Wronka A, Kim ET, Zambrano R, Wollstein G, Schuman JS. Disparities in Visual Field Testing Frequency Among Subjects With Glaucoma. Transl Vis Sci Technol 2024; 13:2. [PMID: 38564202 PMCID: PMC10996970 DOI: 10.1167/tvst.13.4.2] [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: 06/30/2023] [Accepted: 01/23/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Prior evidence suggests racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma. In this study, we considered the effect of baseline glaucoma severity and socioeconomic disadvantage along with other potential confounders such as test reliability, ancillary tests, and glaucoma surgeries on racial disparity in the frequency of VFT. Methods The records of all subjects with a diagnosis of glaucoma who received VFT at an academic, tertiary care facility from January 2018 to December 2021 were accessed. Analysis was performed to compare VFT frequency, the total number of office visits (DoS), and the ratio of VFT frequency to DoS (VFT/DoS) across self-reported races while controlling for sex, age, socioeconomic disadvantage (Area Deprivation Index), VF reliability indicators and baseline mean deviation, optical coherence tomography frequency, and glaucoma surgeries. Results Among the 2654 subjects (1515 White, 782 Black, and 357 Asian) included in this study, Black subjects had the worst socioeconomic status and disease severity at baseline. They also experienced a 3% lower VFT/DoS ratio compared to White subjects (P = 0.031). Asian subjects had a 5% lower VFT/DoS ratio compared to White subjects (P = 0.015). Discussion We identified racial disparity in performing VFT in subjects with glaucoma even when multiple confounders were considered. Further investigation is necessary to identify other race-associated factors to work toward reducing racial disparities in VFT. Translational Relevance Black and Asian subjects with glaucoma receive fewer VFT per visit compared to White subjects even when considering socioeconomic disadvantage and disease severity.
Collapse
Affiliation(s)
- Chisom T Madu
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ting-Fang Lee
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ashley Sohn
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jiyuan Hu
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Rachel Matayev
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Vikram Paranjpe
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jonathan Fam
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Andrew Wronka
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Eleanore T Kim
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | | | - Gadi Wollstein
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Joel S Schuman
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| |
Collapse
|
11
|
Cohen EO, Edelkamp P, Sun J, Leung JWT. Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic. J Am Coll Radiol 2024; 21:576-588. [PMID: 37952808 DOI: 10.1016/j.jacr.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center. METHODS This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach. RESULTS A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations. DISCUSSION At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.
Collapse
Affiliation(s)
- Ethan O Cohen
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Paul Edelkamp
- Division of Information Services, Enterprise Data Engineering, and Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica W T Leung
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
Radomyski P, Trojanowski M, Michalek IM, Kycler W. The impact of the COVID-19 pandemic on clinical staging, pathological staging and surgical management of breast cancer patients. Rep Pract Oncol Radiother 2024; 29:122-130. [PMID: 39165593 PMCID: PMC11333074 DOI: 10.5603/rpor.99357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/26/2024] [Indexed: 08/22/2024] Open
Abstract
Background This study analyzes the impact of the first six lockdown months during the COVID-19 pandemic on breast cancer (BC) patients at a regional cancer center in western Poland (Greater Poland region). Materials and methods Patient age, clinical stage, pathological stage, surgical management, and use of neoadjuvant therapy (NT) for patients diagnosed with BC during the pandemic (March-August 2020, n = 290) were compared with pre-COVID-19 data (March-August 2019, n = 405). Results There were statistically significant differences in the average age (58.2 pre-COVID-19 vs. 55.9 during COVID-19, p = 0.014), clinical stage (p = 0.017) with a stage shift (stage I being dominant pre-pandemic, stage II during the pandemic). Additionally, when comparing the 2019 and 2020 groups, there were statistically significant differences in clinically node-positive cases (27% vs. 37%, p = 0.007), pathologically node-positive cases (26% vs. 34%, p = 0.014), and NT use (27% vs. 43%, p = 0.001). Moreover, there was a notable increase in the prevalence of mastectomies from 44% to 53% (p = 0.017) and axillary lymph node dissections from 27% to 33% (p = 0.029). Conclusions The first six months of the COVID-19 pandemic had a discernible impact on BC patients in the Greater Poland region. Changes in patient age, clinical stage, pathological stage, and treatment approach were observed during this period. These findings underscore the importance of further research and adaptations in healthcare delivery to address the evolving needs of BC patients during times of crisis.
Collapse
Affiliation(s)
- Piotr Radomyski
- Radiology Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland
| | - Irmina Maria Michalek
- Department of Cancer Pathology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Witold Kycler
- Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Poznan, Poland
| |
Collapse
|
13
|
Youn HM, Zhang Y, Liu A, Ng CS, Liang J, Lau GKK, Lee SF, Lok J, Lam CLK, Wan EYF, Quan J. Decline in Cancer Diagnoses during the 'Zero COVID' Policy in Hong Kong: Indirect Spillover Impact of the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2024; 36:157-164. [PMID: 38262779 DOI: 10.1016/j.clon.2024.01.008] [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: 06/21/2023] [Revised: 11/26/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
AIMS Despite a largely successful 'zero COVID' policy in 2020, the COVID-19 pandemic disrupted routine cancer services in the city of Hong Kong. The aims of this study were to examine the trends in cancer incidence before and during the COVID-19 pandemic and estimate missed cancer diagnoses. MATERIALS AND METHODS We used population-based data from the Hong Kong Cancer Registry 1983-2020 to examine the trends of age- and sex-standardised cancer incidence before and during the COVID-19 pandemic. We applied: (i) the annual average percentage change (AAPC) calculated using the Joinpoint regression model and (ii) the autoregressive integrated moving average (ARIMA) model to forecast cancer incidence rates in 2020. Missed cancer diagnoses in 2020 were estimated by comparing forecasted incidence rates to reported rates. A subgroup analysis was conducted by sex, age and cancer site. RESULTS The cancer incidence in Hong Kong declined by 4.4% from 2019 to 2020 (male 8.1%; female 1.1%) compared with the long-term AAPC of 0.5% from 2005 to 2019 (95% confidence interval 0.3, 0.7). The gap between the reported and forecasted incidence for 2020 ranged from 5.1 to 5.7% (male 8.5%, 9.8%; female 2.3%, 3.5%). We estimated 1525-1596 missed cancer diagnoses (ARIMA estimate -98, 3148; AAPC 514, 1729) in 2020. Most missed diagnoses were in males (ARIMA 1361 [327, 2394]; AAPC 1401 [1353, 1460]), with an estimated 479-557 missed cases of colorectal cancer (ARIMA 112, 837; AAPC 518, 597) and 256-352 missed cases of prostate cancer (AAPC 231, 280; ARIMA 110, 594). CONCLUSION The incidence of new cancer diagnoses declined in 2020 contrary to the long-term increase over the previous decades. Significantly lower diagnoses than expected were observed in males, particularly for colorectal and prostate cancers. Fewer reported cancer cases indicate missed diagnoses and could lead to delayed treatment that could impact future health outcomes.
Collapse
Affiliation(s)
- H M Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Y Zhang
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - A Liu
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - C S Ng
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - J Liang
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - G K K Lau
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - S F Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - J Lok
- Department of Pathology, United Christian Hospital, Hong Kong SAR, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - E Y F Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - J Quan
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; HKU Business School, University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
14
|
Mitoma T, Maki J, Ooba H, Ogawa C, Masuyama H, Tabuchi T. Association of Regular Cervical Cancer Screening with Socioeconomic, COVID-19 Infection and Vaccine Status Among Japanese Population: Cohort Observational Study. Int J Gen Med 2024; 17:541-551. [PMID: 38371520 PMCID: PMC10874123 DOI: 10.2147/ijgm.s453675] [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] [Received: 12/06/2023] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Among the Organisation for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening coverages. Cancer screening coverage has worsened due to the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the relationship between socioeconomic background, COVID-19 infection history and vaccine status, and regular cervical cancer screening (CCS) during the two years of the COVID-19 era in Japan. Patients and Methods We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, Internet-based, self-report cohort observational study conducted in 2022. The outcome variable was identified by asking whether the participants had undergone CCS within the last two years. Cervical cytology was performed in Japan by brushing the external cervical os. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate the socioeconomic background variables. Results Of the 12,066 participants, 5597 (46.4%) had undergone regular CCS for over two years. The prevalence ratio (PR) of patients who underwent CCS was 0.70 for those in their 20s and 0.78 for those in their 60s, compared to those in their 40s. Socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million Yen. Our final multivariate analysis revealed that participants who were in their 20s or 60s, had a household income below 4 million Yen, were unmarried, had no annual health check-ups, and were unvaccinated with COVID-19 were at a higher risk of not undergoing CCS. Conclusion The relationship between socioeconomic inequality and CCS hesitancy is prevalent among younger participants. The CCS coverage in Japan during the COVID-19 pandemic year (2020-2022) was not low compared with the pre-pandemic era.
Collapse
Affiliation(s)
- Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hikaru Ooba
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Ogawa
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Tabuchi
- Department of Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
15
|
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.
Collapse
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;
| |
Collapse
|
16
|
Navarro-Sabate A, Font R, Martínez-Soler F, Solà J, Tortosa A, Ribes J, Benito-Aracil L, Espinas JA, Borras JM. The Impact of the COVID-19 Pandemic on Adherence to Endocrine Therapy for Breast Cancer in Catalonia (Spain). Cancers (Basel) 2024; 16:426. [PMID: 38275867 PMCID: PMC10814820 DOI: 10.3390/cancers16020426] [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: 12/18/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Purpose. To assess the impact of the COVID-19 pandemic on adherence to oral endocrine therapy in patients diagnosed with breast cancer in the public healthcare system in Catalonia (Spain). Methods. Retrospective cohort study in patients starting endocrine therapy from 2017 to 2021. Adherence was measured during the first year of treatment, and the impact of the pandemic was calculated according to the calendar year and whether the first year of treatment included the peak period of the pandemic in our setting (March-September 2020). Analyses were performed using a chi-square test and multivariable logistic regression, with results stratified by year, age group, and drug type. Results. Mean overall adherence during the first year of treatment was 89.6% from 2017 to 2021. In contrast, the patients who started treatment in 2019 and 2020 and whose treatment included the peak pandemic period presented an adherence of 87.0% and 86.5%, respectively. Young age and tamoxifen or combination therapy were predictors of low adherence. An increase in neoadjuvant therapy was also observed in 2020. Conclusions. The COVID-19 pandemic had only a modest impact on adherence to endocrine therapy (≈3%), despite the enormous disruptions for patients, the healthcare system in general, and cancer care in particular that were occurring in that period.
Collapse
Affiliation(s)
- Aurea Navarro-Sabate
- Fundamental Care and Clinical Nursing Department, Nursing Faculty, University of Barcelona, 08007 Barcelona, Spain; (A.N.-S.); (F.M.-S.); (A.T.); (L.B.-A.)
| | - Rebeca Font
- Catalan Cancer Plan, Department of Health, 08908 Barcelona, Spain; (R.F.); (J.R.); (J.A.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
| | - Fina Martínez-Soler
- Fundamental Care and Clinical Nursing Department, Nursing Faculty, University of Barcelona, 08007 Barcelona, Spain; (A.N.-S.); (F.M.-S.); (A.T.); (L.B.-A.)
| | - Judit Solà
- Catalan Cancer Plan, Department of Health, 08908 Barcelona, Spain; (R.F.); (J.R.); (J.A.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
| | - Avelina Tortosa
- Fundamental Care and Clinical Nursing Department, Nursing Faculty, University of Barcelona, 08007 Barcelona, Spain; (A.N.-S.); (F.M.-S.); (A.T.); (L.B.-A.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
| | - Josepa Ribes
- Catalan Cancer Plan, Department of Health, 08908 Barcelona, Spain; (R.F.); (J.R.); (J.A.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
- Clinical Sciences Department, University of Barcelona, 08907 Barcelona, Spain
| | - Llúcia Benito-Aracil
- Fundamental Care and Clinical Nursing Department, Nursing Faculty, University of Barcelona, 08007 Barcelona, Spain; (A.N.-S.); (F.M.-S.); (A.T.); (L.B.-A.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
| | - Josep Alfons Espinas
- Catalan Cancer Plan, Department of Health, 08908 Barcelona, Spain; (R.F.); (J.R.); (J.A.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
- Clinical Sciences Department, University of Barcelona, 08907 Barcelona, Spain
| | - Josep Maria Borras
- Catalan Cancer Plan, Department of Health, 08908 Barcelona, Spain; (R.F.); (J.R.); (J.A.E.)
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, 08907 Barcelona, Spain
- Clinical Sciences Department, University of Barcelona, 08907 Barcelona, Spain
| |
Collapse
|
17
|
Kohan A, Menon S, Murad V, Mirshahvalad SA, Kulanthaivelu R, Farag A, Ortega C, Metser U, Veit-Haibach P. Impact of the COVID-19 Pandemic on Staging Oncologic PET/CT Imaging and Patient Outcome in a Public Healthcare Context: Overview and Follow Up of the First Two Years of the Pandemic. Cancers (Basel) 2023; 15:5358. [PMID: 38001619 PMCID: PMC10670509 DOI: 10.3390/cancers15225358] [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: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
To assess the impact of the COVID-19 pandemic on the diagnosis, staging and outcome of a selected population throughout the first two years of the pandemic, we evaluated oncology patients undergoing PET/CT at our institution. A retrospective population of lung cancer, melanoma, lymphoma and head and neck cancer patients staged using PET/CT during the first 6 months of the years 2019, 2020 and 2021 were included for analysis. The year in which the PET was performed was our exposure variable, and our two main outcomes were stage at the time of the PET/CT and overall survival (OS). A total of 1572 PET/CTs were performed for staging purposes during the first 6 months of 2019, 2020 and 2021. The median age was 66 (IQR 16), and 915 (58%) were males. The most prevalent staged cancer was lung cancer (643, 41%). The univariate analysis of staging at PET/CT and OS by year of PET/CT were not significantly different. The multivariate Cox regression of non-COVID-19 significantly different variables at univariate analysis and the year of PET/CT determined that lung cancer (HR 1.76 CI95 1.23-2.53, p < 0.05), stage III (HR 3.63 CI95 2.21-5.98, p < 0.05), stage IV (HR 11.06 CI95 7.04-17.36, p < 0.05) and age at diagnosis (HR 1.04 CI95 1.02-1.05, p < 0.05) had increased risks of death. We did not find significantly higher stages or reduced OS when assessing the year PET/CT was performed. Furthermore, OS was not significantly modified by the year patients were staged, even when controlled for non-COVID-19 significant variables (age, type of cancer, stage and gender).
Collapse
Affiliation(s)
- Andres Kohan
- Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University Medical Imaging Toronto, Toronto, ON M5T 1W7, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Guével E, Priou S, Lamé G, Wassermann J, Bey R, Uzan C, Chatellier G, Belkacemi Y, Tannier X, Guillerm S, Flicoteaux R, Gligorov J, Cohen A, Benderra M, Teixeira L, Daniel C, Hersant B, Tournigand C, Kempf E. Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med 2023; 12:20918-20929. [PMID: 37909210 PMCID: PMC10709737 DOI: 10.1002/cam4.6637] [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: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic. METHODS We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020. RESULTS In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups. CONCLUSIONS Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
Collapse
Affiliation(s)
- Etienne Guével
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Sonia Priou
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Guillaume Lamé
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Johanna Wassermann
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
| | - Romain Bey
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Catherine Uzan
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre‐Université de Paris (APHP‐CUP)Université Paris CItéParisFrance
| | - Yazid Belkacemi
- Assistance Publique–Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Xavier Tannier
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Sophie Guillerm
- Assistance Publique–Hôpitaux de Paris, Department of radiation therapy, Saint Louis University HospitalUniversité Paris CitéCréteilFrance
| | - Rémi Flicoteaux
- Assistance Publique–Hôpitaux de ParisDepartment of medical informationParisFrance
| | - Joseph Gligorov
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Ariel Cohen
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Marc‐Antoine Benderra
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Luis Teixeira
- Assistance Publique–Hôpitaux de Paris, Department of senology, Saint Louis Teaching HospitalUniversité Paris CitéParisFrance
| | - Christel Daniel
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Barbara Hersant
- Assistance Publique – Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Christophe Tournigand
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Emmanuelle Kempf
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | | |
Collapse
|
19
|
Manzella A, Eskander MF, Grandhi MS, In H, Langan RC, Kennedy T, August D, Alexander HR, Beninato T, Pitt HA. COVID-19 Effect on Surgery for Gastrointestinal Malignancies: Have Operative Volumes Recovered? J Gastrointest Surg 2023; 27:2538-2546. [PMID: 37749458 DOI: 10.1007/s11605-023-05838-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND COVID-19 disrupted elective operations, cancer screening, and routine medical care while simultaneously overwhelming hospital staff and supplies. Operations for gastrointestinal (GI) malignancies rely on endoscopic screening, staging, and neoadjuvant therapy (NAT), each of which was disrupted by the pandemic. The aim was to evaluate the effect of the COVID-19 pandemic on the US national rates of gastrointestinal oncologic operations. METHODS The Vizient Clinical Data Base® was queried for oncologic operations for esophageal, gastric, and colorectal malignancies with and without NAT from March 2019 to March 2022. Control chart analysis examined operative volume over time while Wilcoxon rank sum tests were used to compare mean monthly volume before and during the pandemic. RESULTS A total of 95,912 patients were identified over 36 months; 5.8% esophageal, 6.3% gastric, 77.5% colonic, and 10.4% rectal operations. Esophageal operative volume decreased for 9 months during the pandemic and was significantly lower during than before the pandemic (p=0.002). Gastric operations decreased for 10 months early in the pandemic, but rebounded so that after 2 years volumes were unchanged (p=0.49). Colonic operations experienced a sharp decrease for 4 months at the beginning of the pandemic, but volumes quickly increased and overall were unchanged (p=0.29). Rectal operations decreased for 13 months and were significantly lower during than before the pandemic (p=0.018). Oncologic operations for patients receiving NAT varied. CONCLUSION COVID-19 significantly disrupted the volume of gastrointestinal oncologic operations in the USA. Esophageal and rectal oncologic operations experienced prolonged and significant reductions while gastric and colonic oncologic operations transiently decreased but rebounded during the pandemic.
Collapse
Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Mariam F Eskander
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Miral S Grandhi
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Haejin In
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Russell C Langan
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Timothy Kennedy
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - David August
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - H Richard Alexander
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Hagenbeck C, Soff J, Mause L, Hoffmann J, Ohnhäuser T, Stöcker A, Zöllkau J, Scholten N. Gynaecologists' perceptions of outpatient gynaecologic and obstetric care in Germany during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:1079. [PMID: 37817213 PMCID: PMC10566176 DOI: 10.1186/s12913-023-10045-1] [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: 02/21/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
The measures taken to contain the COVID-19 pandemic had a major impact on society, affecting medical care as well as the utilization of medical services. We aimed to identify pandemic-related changes in gynaecologic/obstetric care through the personal experience of practitioners in the outpatient sector in Germany. Three consecutive anonymous online surveys of practising gynaecologists were conducted during the pandemic (07-09/2020, 11-12/2020 and 09-11/2021). Appointment management, medical supply and patients' demand as well as concomitant circumstances were queried. Data from 860 (393, 262 and 205 from the first, second and third surveys, respectively) respondents were analysed. At the peak of the first COVID-19 wave, more than 50% of the gynaecologists surveyed had cancelled cancer screening appointments. There was a significant association between fear of self-infection and cancellation of cancer screening appointments (p = 0.006). An increase in domestic violence was reported by 13%, an increase in obesity by 67% and more advanced tumours due to delayed screening by 24% of respondents. Primary gynaecological oncological prevention was reduced in supply and demand during the COVID-19 pandemic, and this shortfall should be addressed in future similar situations. Prenatal care has been offered continuously since the start of the pandemic in Germany.
Collapse
Affiliation(s)
- Carsten Hagenbeck
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Johannes Soff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Laura Mause
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Jan Hoffmann
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Tim Ohnhäuser
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Arno Stöcker
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Scholten
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| |
Collapse
|
22
|
Bose S, Basu P, Mandal R, Chakrabarti J, Vernekar M, Banerjee D, Chatterjee P, Ray C. A Study of the Impact and Restitutive Efforts of Cervical Cancer Screening during the COVID-19 Pandemic in a Regional Cancer Centre in Eastern India. Asian Pac J Cancer Prev 2023; 24:3495-3500. [PMID: 37898855 PMCID: PMC10770680 DOI: 10.31557/apjcp.2023.24.10.3495] [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: 04/25/2023] [Accepted: 10/07/2023] [Indexed: 10/30/2023] Open
Abstract
AIM To evaluate the feasibility and efficacy of switching to a self-sampling based screening as compared to ongoing provider-collection based screening using HPV DNA test and assess the compliance of HPV positive women for further treatment during the COVID 19 pandemic. METHOD The study participants were women aged 30-60 years from rural and semi-urban communities around Kolkata, who underwent screening followed by HPV testing by Hybrid Capture II test. In the pre pandemic era, the women who attended the health centres where trained health workers that collected cervical samples. Following lockdown, the health workers distributed the self-sampling device to the women during home visits and counselled them to collect their samples by themselves. Thereafter the self collected screened positive women were brought to the hospital for further treatment instead of community clinics. RESULTS From April 2018 to March 2020, 12,718 women underwent screening using either HPV DNA test or visual inspection with acetic acid. HPV samples were either provider collected (62.7%) or self-collected (37.2%). The HPV positivity and CIN2+ detection rate were 5.4% and 2%. From April 2020 to February 2022, 10,792 women underwent screening using self-sampling only. The HPV positivity rate and CIN2+ detection rate were found to be 5.1% and 1.9 % . CONCLUSION Cervical cancer screening by HPV self-sampling advocates participation of more women especially in rural areas, while accelerating progress towards elimination of cervical cancer.
Collapse
Affiliation(s)
- Sreeya Bose
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (WHO), Lyon, France.
| | - Ranajit Mandal
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Jayanta Chakrabarti
- Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Manisha Vernekar
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Dipanwita Banerjee
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Puja Chatterjee
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| | - Chandrima Ray
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
| |
Collapse
|
23
|
Inoue D, Orisaka M, Hirose H, Miyashita H, Yamada S, Tsuyoshi H, Shinagawa A, Kurokawa T, Yoshida Y. Attitudes toward cancer screening in regional Japan during the COVID-19 pandemic: An anonymous survey. Cancer Sci 2023; 114:4081-4088. [PMID: 37605505 PMCID: PMC10551611 DOI: 10.1111/cas.15931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has raised concerns about the impact of delayed health check-ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open-data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies.
Collapse
Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Makoto Orisaka
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hiroaki Hirose
- Department of Health and WelfareFukui PrefectureFukuiJapan
| | | | - Shizuka Yamada
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Akiko Shinagawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Tetsuji Kurokawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Yoshio Yoshida
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| |
Collapse
|
24
|
Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Whitmer A, Michel A, McIntyre M, Rossi SL, Kajtezovic S, Vadaparampil ST, Perkins R. Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study. eLife 2023; 12:e86358. [PMID: 37664989 PMCID: PMC10476963 DOI: 10.7554/elife.86358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Methods Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. Results A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Conclusions Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
Collapse
Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health SciencesCharlestonUnited States
| | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Sidika Kajtezovic
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| |
Collapse
|
25
|
Fuzzell L, Brownstein NC, Fontenot HB, Lake PW, Michel A, Whitmer A, Rossi SL, McIntyre M, Vadaparampil ST, Perkins RB. Examining the association of clinician characteristics with perceived changes in cervical cancer screening and colposcopy practice during the COVID-19 pandemic: a mixed methods assessment. eLife 2023; 12:e85682. [PMID: 37656169 PMCID: PMC10473834 DOI: 10.7554/elife.85682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. Methods In 2021, a national sample of 1251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Results Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, as well as internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, internal medicine physicians and those practicing in community health centers had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Conclusions Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than 1 year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
Collapse
Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | | | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Paige W Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| |
Collapse
|
26
|
Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01749-5. [PMID: 37603223 DOI: 10.1007/s40615-023-01749-5] [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: 02/01/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions. METHODS We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool. RESULTS After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos. CONCLUSIONS Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.
Collapse
Affiliation(s)
| | - Mitchell Silva
- Esperity, Veldkapelgaarde 30b1.30.30, 1200, Brussels, Belgium
| | - Jose Maria Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Shaantanu Donde
- Viatris, Building 4, Trident Place, Mosquito Way, Hatfield, AL10 9UL, UK
| | | | - Joris van Vugt
- Viatris, Krijgsman 20, Amstelveen, 1186DM, The Netherlands
| |
Collapse
|
27
|
Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review. Eur J Cancer Prev 2023; 32:396-409. [PMID: 37144585 PMCID: PMC10249608 DOI: 10.1097/cej.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care. METHODS We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies. RESULTS After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n = 10), breast ( n = 4), cervical ( n = 2), and prostate ( n = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous. CONCLUSION Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.
Collapse
Affiliation(s)
| | | | - Jose M. Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, Centre for Research in Health Systems Performance, Singapore, Singapore
| | - Shaantanu Donde
- European Developed Markets Medical Affairs Viatris, Hatfield, UK
| | - Seth Woodruff
- North America Medical Affairs, Viatris, New York, USA
| | | |
Collapse
|
28
|
Johnson G, Miquel-Chambers C, Blas Y, Lowery S, Guerra L, Gonzalez E. Women's Health Maintenance Efforts at a Student-Run Free Clinic in South Florida Exceeded National Trends During the COVID-19 Pandemic. J Community Health 2023; 48:501-507. [PMID: 36719533 PMCID: PMC9887570 DOI: 10.1007/s10900-023-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic posed a setback to health maintenance screenings worldwide. These delays have impacted minorities and those of low socioeconomic status in the same way that disparities in cancer screenings have historically trended. Here, we evaluated the performance of a student-run free clinic in maintaining women up-to-date with cancer screenings before, during, and after the pandemic in relation to national trends. We identified all women eligible for screening mammography and cervical cancer screenings between 2018 and 2022 at the clinic (N = 185). Adequate adherence to screening was defined according to the American Cancer Society (ACS) recommendations for breast mammography, and the United States Preventive Services Task Force (USPSTF) guidelines for cervical cancer screenings. For cervical cancer screening, 166 female patients seen between 2018 and 2022 were eligible, and up-to-date proportions were as follows: 81.3% in 2018; 90.9% in 2019; 83.3% in 2020; 93.3% in 2021; 93.8% in 2022. For breast surveillance, 143 women were eligible for screening mammography, and up-to-date proportions were as follows: 66.7% in 2018; 62.5% in 2019; 91.7% in 2020; 73.1% in 2021; 84.1% in 2022. These proportions were higher than or near national averages.In conclusion, adherence remained steady during the pandemic and was not subject to the declines seen nationally. Our clinic represents an effective model for promoting women's health maintenance and tempering the disparities seen among women of low socioeconomic status.
Collapse
Affiliation(s)
- Grace Johnson
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | | | - Yohancie Blas
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Sylea Lowery
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Eduardo Gonzalez
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| |
Collapse
|
29
|
Griewing S, Wagner U, Lingenfelder M, Fischer R, Kalder M. Chronological development of in-patient oncology in times of COVID-19: a retrospective analysis of hospitalized oncology and COVID-19 patients of a German University Hospital. J Cancer Res Clin Oncol 2023; 149:2551-2558. [PMID: 35771262 PMCID: PMC9244885 DOI: 10.1007/s00432-022-04044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017-19) and pandemic (2020-21) years in the setting of a German university maximum care provider. METHODS Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with oncological main (nOnco) and COVID-19 secondary diagnosis (nCOVID-19). Data analysis is based on descriptive statistical assessment. RESULTS The oncology patient collective (nOnco = 27,919) shows a decrease of hospitalized patients for the whole pandemic (- 4% for 2020 and - 2,5% for 2021 to 2019). The number of hospitalized COVID-19 patients increases from first to second pandemic year by + 106.71% (nCOVID-19 = 868). Maximum decline in monthly hospitalized oncology patients amounts to - 19% (May 2020) during the first and - 21% (December 2020) during the second lockdown. Relative monthly hospitalization levels of oncology patients reverted to pre-pandemic levels from February 2021 onwards. CONCLUSION The results confirm a decline in hospitalized oncology patients for the entire pandemic in the setting of a maximum care provider. Imposed lockdown and contact restrictions, rising COVID-19 case numbers, as well as discovery of new virus variants have a negative impact on hospitalized treated oncological patients.
Collapse
Affiliation(s)
- Sebastian Griewing
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
- Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany.
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Michael Lingenfelder
- Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany
| | - Rebecca Fischer
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| |
Collapse
|
30
|
Wong SC, Chau PH, So SYC, Chiu KHY, Yuen LLH, AuYeung CHY, Lam GKM, Chan VWM, Chen JHK, Chen H, Li X, Ho PL, Chan SSC, Yuen KY, Cheng VCC. Epidemiology of multidrug-resistant organisms before and during COVID-19 in Hong Kong. Infect Prev Pract 2023; 5:100286. [PMID: 37223243 PMCID: PMC10165868 DOI: 10.1016/j.infpip.2023.100286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has influenced antimicrobial consumption and incidence of multidrug-resistant organisms (MDROs). We aimed to study the epidemiology of MDROs before and during the COVID-19 pandemic in Hong Kong. Methods With the maintenance of infection control measures, we described the trend of MDRO infections, including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum-beta-lactamase-(ESBL)-producing Enterobacterales, in a healthcare region with 3100-bed before (1 January 2016 to 31 December 2019, period 1) and during COVID-19 (1 January 2020 to 30 September 2022, period 2), together with the antimicrobial consumption using piecewise Poisson regression. The epidemiological characteristics of newly diagnosed COVID-19 patients with or without MDRO infections were analyzed. Results Between period 1 and 2, we observed a significant increase in the trend of CRA infections (P<0.001), while there was no significant increase in the trend of MRSA (P=0.742) and ESBL-producing Enterobacterales (P=0.061) infections. Meanwhile, a significant increase in the trend of carbapenems (P<0.001), extended-spectrum beta-lactam-beta-lactamase inhibitor combinations (BLBI) (P=0.045), and fluoroquinolones (P=0.009) consumption was observed. The observed opportunity (23,540 ± 3703 vs 26,145 ± 2838, p=0.359) and compliance (81.6% ± 0.5% vs 80.1% ± 0.8%, P=0.209) of hand hygiene per year was maintained. In a multivariable model, older age, male sex, referral from residential care home for the elderly, presence of indwelling device, presence of endotracheal tube, and use of carbapenems, use of BLBI, use of proton pump inhibitors and history of hospitalization in the past 3 months were associated with higher risks of infections by MDROs among COVID-19 patients. Conclusion Infection control measures may control the surge of MDROs despite an increasing trend of antimicrobial consumption.
Collapse
Affiliation(s)
- Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Pui-Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Yung-Chun So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Lithia Lai-Ha Yuen
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Christine Ho-Yan AuYeung
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Germaine Kit-Ming Lam
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Veronica Wing-Man Chan
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Jonathan Hon-Kwan Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Hong Chen
- Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Xin Li
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sophia Siu-Chee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Carol Yu Center for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Chi-Chung Cheng
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| |
Collapse
|
31
|
Hui S, Sane N, Wang A, Wan L, Bell S, Le S, Dev A. Hepatocellular carcinoma surveillance in the telehealth era: A single-centre review. J Telemed Telecare 2023:1357633X231166032. [PMID: 37032467 DOI: 10.1177/1357633x231166032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Real-world hepatocellular carcinoma (HCC) surveillance uptake remains suboptimal, despite evidence that surveillance is associated with lower cancer-related mortality in patients with cirrhosis and chronic hepatitis B. We aimed to examine the impact of telehealth consultations on HCC surveillance rates within a specialist liver clinic. METHODS We conducted a retrospective observational study within an Australian outreach liver clinic within a culturally diverse community, comparing standard consultations before the COVID-19 pandemic to telehealth consultations during the pandemic. The primary outcome was surveillance uptake defined as the percentage of time up-to-date with surveillance (PTUDS) with the 6-month interval following each scan considered up-to-date. RESULTS Over 18 months of follow-up for each cohort, the median PTUDS was 86.5% in the standard consultation cohort and 85.5% in the telehealth consultation cohort (p = 0.12). HCC diagnoses did not differ between groups and hospitalisation and mortality rates were low. Using multivariate regression, increasing age, the need for an interpreter and being born in South-East Asia independently predicted PTUDS in the standard consultation cohort, whereas being born in Australia or New Zealand was predictive of a lower PTUDS. Current alcohol use and distance from the clinic predicted a lower PTUDS in the telehealth consultation cohort. In both groups, missed clinic attendances were strongly predictive of a lower PTUDS. CONCLUSION Telehealth hepatology consultations effectively coordinate HCC surveillance and are associated with similar outcomes to standard consultations. Its implementation should be widely considered given its advantages with regards to accessibility for patients.
Collapse
Affiliation(s)
- Samuel Hui
- School of Clinical Sciences at Monash Health, 2541Monash University, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| | - Nikhita Sane
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| | - Andrew Wang
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| | - Leo Wan
- School of Clinical Sciences at Monash Health, 2541Monash University, Melbourne, Victoria, Australia
| | - Sally Bell
- School of Clinical Sciences at Monash Health, 2541Monash University, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| | - Suong Le
- School of Clinical Sciences at Monash Health, 2541Monash University, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| | - Anouk Dev
- School of Clinical Sciences at Monash Health, 2541Monash University, Melbourne, Victoria, Australia
- Department of Gastroenterology and Hepatology, 2538Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
32
|
Ramírez-Soto MC, Salazar-Peña M, Vargas-Herrera J. Estimating Excess Mortality Due to Prostate, Breast, and Uterus Cancer during the COVID-19 Pandemic in Peru: A Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5156. [PMID: 36982065 PMCID: PMC10049374 DOI: 10.3390/ijerph20065156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, most of the deaths in Peru were related to COVID-19; however, cancer deaths have also been exacerbated in the first months of the pandemic. Despite this, excess mortalities of prostate, breast, and uterus cancer are not available by age group and region from January to December 2020. Therefore, we estimated the excess deaths and excess death rates (per 100,000 habitants) due to prostate, breast, and uterus cancer in 25 Peruvian regions. We did a time series analysis. Prostate, breast, and uterus cancer death data for 25 Peruvian regions were retrieved during the COVID-19 pandemic in 2020, as well as data for up to 3 years prior (2017-2019) from the Sistema Informatico Nacional de Defunciones at the Ministry of Health of Peru. Deaths in 2020 were defined as observed deaths. The expected deaths (in 2020) were estimated using the average deaths over 3 preceding years (2017, 2018 and 2019). Excess mortality was calculated as the difference between observed mortality and expected mortality in 2020. We estimated that the number of excess deaths and the excess death rates due to prostate, breast, and uterus cancer were 610 deaths (55%; 12.8 deaths per 100,000 men), 443 deaths (43%; 6 deaths per 100,000 women), and 154 deaths (25%; 2 deaths per 100,000 women), respectively. Excess numbers of deaths and excess death rates due to prostate and breast cancer increased with age. These excess deaths were higher in men aged ≥ 80 years (596 deaths (64%) and 150 deaths per 100,000 men) and women aged 70-79 years (229 deaths (58%) and 15 deaths per 100,000 women), respectively. In summary, during the COVID-19 pandemic, there were excess prostate and breast cancer mortalities in 2020 in Peru, while excess uterus cancer mortalities were low. Age-stratified excess death rates for prostate cancer and breast cancer were higher in men ≥ 80 years and in women ≥ 70 years, respectively.
Collapse
Affiliation(s)
| | | | - Javier Vargas-Herrera
- Unidad de Telemedicina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima 15001, Peru;
| |
Collapse
|
33
|
Martins TR, Witkin SS, Mendes-Corrêa MC, de Godoy AS, Cury L, Balancin ML, Ab'Saber AM, Peres SV, Messias S, Tozetto Mendoza TR, Longatto-Filho A. IMPACT OF THE COVID-19 PANDEMIC ON CERVICAL CANCER SCREENING IN SÃO PAULO STATE, BRAZIL. Acta Cytol 2023:000529249. [PMID: 36682351 PMCID: PMC10025367 DOI: 10.1159/000529249] [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: 11/17/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The early identification of precursor lesions followed by appropriate treatment prevents development of cervical cancer and its consequences OBJECTIVE: The present study evaluated the influence of the Covid-19 pandemic on cervical cancer screening by comparing the quantity of tests to detect cervical cellular changes performed in Sao Paulo state in 2019, prior to the detection of SARS-CoV-2 in Brazil, to the first (2020) and second (2021) years following its appearance. MATERIALS AND METHODS Data from Fundação Oncocentro de São Paulo (FOSP), the agency that analyses approximately 220,000 Pap tests annually, was reviewed. RESULTS A median of 1835 Papanicolaou (Pap) tests were performed in 55 municipalities in 2019. This was reduced to 815 tests in 2020, a 56% decrease (p = 0.0026). In 2021, the median number was 1745, a 53% increase over 2020 levels (p = 0.0233). The 26 municipalities with >1000 tests in 2020 had a median reduction from 4433 in 2019 to 2580 in 2020 (p = 0. 0046). The 29 municipalities with <1000 tests had a median reduction from 951 in 2019 to 554 in 2020 (p < 0.0001). There was a 44% reduction in the number of follow-up cytological evaluations from 2019 to 2020, followed by a 30% increase the following year. However, the percentage of women with a normal finding or with any abnormality remained unchanged. The findings from a histological evaluation of women in Sao Paulo city indicated that the percent of cases positive for CIN-1 (p<0.0410) and CIN-3 (p<0.0012) increased in 2020 and 2021 as compared to 2019 levels. CONCLUSION A reduction in testing for cervical cancer in the first year of the Covid-19 pandemic, accompanied by an elevated incidence of precancerous lesions in each of the first two years following its initiation, may portend a subsequent increased occurrence of cervical cancer in Brazil.
Collapse
Affiliation(s)
- Toni Ricardo Martins
- University of São Paulo School of Medicine, LIM/52, Tropical Medicine Institute, São Paulo, Brazil
- Infectious Diseases Department, University of São Paulo School of Medicine, São Paulo, Brazil
- Professor at Paulista University, Biomedicina Undergraduate Course, São Paulo, Brazil
- *Toni Ricardo Martins,
| | - Steven S. Witkin
- University of São Paulo School of Medicine, LIM/52, Tropical Medicine Institute, São Paulo, Brazil
- Department of Obstetrics and Gynecology, Weill Cornel Medicine, New York, New York, USA
| | - Maria Cássia Mendes-Corrêa
- University of São Paulo School of Medicine, LIM/52, Tropical Medicine Institute, São Paulo, Brazil
- Infectious Diseases Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Lise Cury
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | | | | | | | - Sandra Messias
- Coordination of the Undergraduate Course in Biomedicine, Paulista University, São Paulo, Brazil
| | | | - Adhemar Longatto-Filho
- Teaching and Research Institute, And Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- ICVS/3B's, Associated Laboratory to the Government of Portugal, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- Department of Pathology, Medical Laboratory of Medical Investigation (LIM), Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
34
|
Di Fusco M, Mendes D, Steuten L, Bloom DE, Drummond M, Hauck K, Pearson-Stuttard J, Power R, Salisbury D, Towse A, Roiz J, Szabo G, Yang J, Marczell K. The Societal Value of Vaccines: Expert-Based Conceptual Framework and Methods Using COVID-19 Vaccines as a Case Study. Vaccines (Basel) 2023; 11:234. [PMID: 36851112 PMCID: PMC9961127 DOI: 10.3390/vaccines11020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
Health technology assessments (HTAs) of vaccines typically focus on the direct health benefits to individuals and healthcare systems. COVID-19 highlighted the widespread societal impact of infectious diseases and the value of vaccines in averting adverse clinical consequences and in maintaining or resuming social and economic activities. Using COVID-19 as a case study, this research work aimed to set forth a conceptual framework capturing the broader value elements of vaccines and to identify appropriate methods to quantify value elements not routinely considered in HTAs. A two-step approach was adopted, combining a targeted literature review and three rounds of expert elicitation based on a modified Delphi method, leading to a conceptual framework of 30 value elements related to broader health effects, societal and economic impact, public finances, and uncertainty value. When applying the framework to COVID-19 vaccines in post-pandemic settings, 13 value elements were consensually rated highly important by the experts for consideration in HTAs. The experts reviewed over 10 methods that could be leveraged to quantify broader value elements and provided technical forward-looking recommendations. Limitations of the framework and the identified methods were discussed. This study supplements ongoing efforts aimed towards a broader recognition of the full societal value of vaccines.
Collapse
Affiliation(s)
- Manuela Di Fusco
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
| | - Diana Mendes
- Health & Value, Pfizer Co., Ltd., Tadworth KT20 7NS, UK
| | | | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Michael Drummond
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Health Analytics, Lane Clark & Peacock, London W1U 1DQ, UK
| | - Rachel Power
- The Patients Association, PO Box 935, Harrow HA1 3YJ, UK
| | - David Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London SW1Y 4LE, UK
| | | | - Julie Roiz
- Evidence, Value and Access by PPD, Evidera, London W6 8BJ, UK
| | - Gabor Szabo
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
| | - Jingyan Yang
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
- Institute for Social and Economic Research and Policy, Graduate School of Arts and Science, Columbia University, New York, NY 10027, USA
| | - Kinga Marczell
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
| |
Collapse
|
35
|
Song X, Yang Y. Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19. Biotechnol Genet Eng Rev 2023:1-13. [PMID: 36641596 DOI: 10.1080/02648725.2023.2166723] [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: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study aims to compare the results of cervical cancer screening in Shanghai General Hospital before and after the COVID-19 epidemic, and analyze the current status and related influencing factors of precervical cancer screening in our hospital under the COVID-19 pandemic. METHODS The data of 13,748 women of cervical precancer screening with HPV in Shanghai General Hospital were selected.The data included human papillomavirus (HPV), thin-layer liquid-based cytology test (TCT), colposcopy and cervical biopsy, and pathological diagnosis results after trachelectomy in 2019 and 2020, and were analyzed and compared. RESULTS The detection rates of precancerous lesions and cervical cancer were 2.9061/10,000 and 29.26/10,000 respectively. There was a significant difference in the rate of comparison (χ2 = 30.361, P = 0.000; χ2 = 7.682, P = 0.006);(2) Missing detection rate: In 2020, other positive subtypes other than HPV 16 and 18 who need TCT, the colposcopy, and the histopathological examination missing detection rate were higher than those in 2019 (P < 0.05);(3) Abnormal rate of examination: the abnormal rate of HPV, TCT, and histopathology in 2020 was higher than those in 2019 (P < 0.05);(4) Histopathological analysis: The detection rate of high-grade lesions and invasive cancer in 2020 was higher than those in 2019, and the detection rate of low-grade lesions was lower than that in 2019 (P < 0.05); Conclusion: Health authorities should formulate intervention measures to cope with the safe and timely implementation of cervical cancer screening and subsequent follow-up management during public health emergency.
Collapse
Affiliation(s)
- Xiaohong Song
- Department of Gynecology and Obstetrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR, China
| | - Yongbin Yang
- Department of Gynecology and Obstetrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, PR, China
| |
Collapse
|
36
|
Sokale IO, Montealegre JR, Oluyomi AO, Thrift AP. Trends and Racial/Ethnic Differences in Predictors of Cervical Cancer Screening among US Women Ages 30-64 Years. Cancer Epidemiol Biomarkers Prev 2023; 32:82-90. [PMID: 36306382 PMCID: PMC9839647 DOI: 10.1158/1055-9965.epi-22-0970] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) participation has decreased in the United States over the last several decades, contributing to cervical cancer's sustained incidence and mortality. This study examined recent trends and racial/ethnic differences in predictors of CCS uptake among US women. METHODS We analyzed combined data from the 2016 to 2020 Behavioral Risk Factor Surveillance System (BRFSS) and included 235,713 women ages 30 to 64 years without a hysterectomy. We used simple linear regression to assess trends over time and multivariable logistic regression models to evaluate racial/ethnic differences in predictors of up-to-date CCS. RESULTS We found little change in CCS over the 5-year interval and screening rates disparities among racial minority women. The overall population showed stable CCS completion rates from 2016 to 2018 (84.2% vs. 84.6%), and then a small dip from 2018 to 2020 (from 84.6% to 83.3%). Despite a slight decline in 2020, HPV-based testing increased significantly among all subgroups and overall, from 2016 to 2020 (from 43.4% to 52.7%). Multivariable regression models showed racial/ethnic differences in predictors of CCS. Across all racial/ethnic subgroups, older women were less likely to receive timely screening. Women who had routine check-ups had higher odds of being up to date. However, the link between CCS and socioeconomic status varied. CONCLUSIONS Age and racial/ethnic disparities persist in CCS, and predictors of screening vary. Notwithstanding, routine health examinations was positively associated with screening regardless of race/ethnicity. IMPACT Our analyses suggest that leveraging primary care to optimize CCS uptake may reduce gaps in screening.
Collapse
Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jane R. Montealegre
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| |
Collapse
|
37
|
Li T, Nickel B, Ngo P, McFadden K, Brennan M, Marinovich ML, Houssami N. A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis. Breast 2023; 67:78-88. [PMID: 36646004 PMCID: PMC9813855 DOI: 10.1016/j.breast.2023.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis. METHODS Seven databases (January 2020-March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach. RESULTS Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0-1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported. CONCLUSIONS Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed.
Collapse
Affiliation(s)
- Tong Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Preston Ngo
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kathleen McFadden
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Meagan Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
38
|
Rocha AFBM, Freitas-Junior R, Ferreira GLR, Rodrigues DCN, Rahal RMS. COVID-19 and Breast Cancer in Brazil. Int J Public Health 2023; 68:1605485. [PMID: 36938303 PMCID: PMC10020228 DOI: 10.3389/ijph.2023.1605485] [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: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.
Collapse
Affiliation(s)
- Aline Ferreira Bandeira Melo Rocha
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil
- *Correspondence: Aline Ferreira Bandeira Melo Rocha,
| | - Ruffo Freitas-Junior
- Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás, Goiânia, Brazil
| | | | | | | |
Collapse
|
39
|
Furlam TDO, Gomes LM, Machado CJ. [COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. CIENCIA & SAUDE COLETIVA 2023; 28:223-230. [PMID: 36629566 DOI: 10.1590/1413-81232023281.06442022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/10/2022] [Indexed: 01/11/2023] Open
Abstract
The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).
Collapse
Affiliation(s)
- Tiago de Oliveira Furlam
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Luiza Moreira Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Carla Jorge Machado
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG. Belo Horizonte MG Brasil
| |
Collapse
|
40
|
Siebenhofer A, Scott AM, Avian A, Terebessy A, Mergenthal K, Schaffler-Schaden D, Bachler H, Huter S, Zelko E, Murray A, Guppy M, Piccoliori G, Streit S, Jeitler K, Flamm M. COVI-Prim international: Similarities and discrepancies in the way general practices from seven different countries coped with the COVID-19 pandemic. Front Public Health 2022; 10:1072515. [PMID: 36600939 PMCID: PMC9806865 DOI: 10.3389/fpubh.2022.1072515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives General practitioners (GPs) are frequently patients' first point of contact with the healthcare system and play an important role in identifying, managing and monitoring cases. This study investigated the experiences of GPs from seven different countries in the early phases of the COVID-19 pandemic. Design International cross-sectional online survey. Setting General practitioners from Australia, Austria, Germany, Hungary, Italy, Slovenia and Switzerland. Participants Overall, 1,642 GPs completed the survey. Main outcome measures We focused on how well-prepared GPs were, their self-confidence and concerns, efforts to control the spread of the disease, patient contacts, information flow, testing procedures and protection of staff. Results GPs gave high ratings to their self-confidence (7.3, 95% CI 7.1-7.5) and their efforts to control the spread of the disease (7.2, 95% CI 7.0-7.3). A decrease in the number of patient contacts (5.7, 95% CI 5.4-5.9), the perception of risk (5.3 95% CI 4.9-5.6), the provision of information to GPs (4.9, 95% CI 4.6-5.2), their testing of suspected cases (3.7, 95% CI 3.4-3.9) and their preparedness to face a pandemic (mean: 3.5; 95% CI 3.2-3.7) were rated as moderate. GPs gave low ratings to their ability to protect staff (2.2 95% CI 1.9-2.4). Differences were identified in all dimensions except protection of staff, which was consistently low in all surveyed GPs and countries. Conclusion Although GPs in the different countries were confronted with the same pandemic, its impact on specific aspects differed. This partly reflected differences in health care systems and experience of recent pandemics. However, it also showed that the development of structured care plans in case of future infectious diseases requires the early involvement of primary care representatives.
Collapse
Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QL, Australia
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - András Terebessy
- Department of Public Health-Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Karola Mergenthal
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Bachler
- Institute of General Practice, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Erika Zelko
- Faculty of Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Amanda Murray
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QL, Australia
| | - Michelle Guppy
- School of Rural Medicine and New England GP Research Network, University of New England, Armidale, NSW, Australia
| | - Giuliano Piccoliori
- Institute for Special Training in General Medicine, Institute of General Practice, Claudiana Bozen, Bolzano, Italy
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Klaus Jeitler
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
41
|
Bohn JA, Fitch KC, Currier JJ, Bruegl A. HPV self-collection: what are we waiting for? Exploration of attitudes from frontline healthcare providers. Int J Gynecol Cancer 2022; 32:1519-1523. [PMID: 36351745 DOI: 10.1136/ijgc-2022-003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Polymerase chain reaction based human papilloma virus (HPV) self-collection for cervical cancer screening is well established. It is utilized worldwide, accepted by patients, is cost-effective, has comparable sensitivity to provider-collected samples, and increases screening rates, however clinical practice in the United States has not shifted to include HPV self-collection. This study sought to examine provider knowledge and attitudes to better understand why HPV self-collection is not being utilized. METHODS An observational, qualitative study was conducted. Data were collected with semi-structured focus groups and individual interviews with Oregon healthcare providers. Focus groups and interviews were continued until data saturation was achieved. A grounded theory method was used for analysis, a cyclical process of coding data, memo-writing, and theoretical sampling to the point of saturation. RESULTS Eighteen healthcare providers participated in the focus group and interviews. They represented 14 of 36 counties across Oregon and 50% were physicians, 33% were nurse practitioners, and 94% worked within family medicine. All providers performed cervical cancer screening according to current American Society for Colposcopy and Cervical Pathology guidelines. Five overarching themes emerged: provider concerns, clinical and provider barriers, patient perspective and barriers, process-based themes, and barriers to cervical cancer screening. Nearly all providers stated they will offer HPV self-collection to most of their patients once available. CONCLUSION While providers identified concerns and barriers for initiating HPV self-collection, there was a strong desire to implement HPV self-collection and acceptance within patient populations was assumed. Providers indicated the need for HPV self-collection to be incorporated into national screening guidelines along with best practices on how to successfully implement this modality to further increase cervical cancer screening rates.
Collapse
Affiliation(s)
- Jacqueline A Bohn
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Katherine C Fitch
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Jessica J Currier
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| |
Collapse
|
42
|
COVID-19 related decline in cancer screenings most pronounced for elderly patients and women in Germany: a claims data analysis. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04433-z. [DOI: 10.1007/s00432-022-04433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to analyze the utilization of cancer screenings in Germany before and during the COVID-19 pandemic in 2020. The objective of the analysis was to identify the population at particular risk and to derive recommendations for the future use of resources to prevent long-term deteriorations in health outcomes.
Methods
The analysis was conducted based on claims data of all preventive health services for 15,833,662 patients from the largest statutory health insurance fund in Germany. Utilization of general female cancer screening, general male cancer screening, general health checkup, colorectal cancer screening stool test, colorectal cancer screening consultation, colonoscopy, skin cancer screening, and mammography screening was compared before (2017–2019) and during (2020) the pandemic.
Results
Data of a total of 42,046,078 observed screenings showed that the utilization of the individual screenings developed differently, but that the overall utilization decreased significantly by 21.46% during the COVID-19 pandemic (p < 0.001). At the same time, no catch-up effects were detected for total screenings throughout the entire year 2020. The highest decline in screenings was found for the elderly (p < 0.001) and women (p < 0.001).
Conclusion
Because the elderly are at higher risk for cancer, the omission of early detection might lead to higher treatment costs, reduced quality of life, and higher mortality. In addition, women's medical care in particular has been negatively affected, for example, by the interruption of mammography screenings and the lack of catch-up effects. Therefore, resources must be targeted to reduce burdens on health outcomes and public health in the long term.
Collapse
|
43
|
Lou J, Kooragayala K, Williams JP, Sandilos G, Butchy MV, Yoon-Flannery K, Kwiatt M, Hong YK, Shersher DD, Burg JM. The Early Impact of the COVID-19 Pandemic on Lung, Colorectal, and Breast Cancer Screening and Treatment at a Tertiary Cancer Center. Am J Clin Oncol 2022; 45:381-390. [PMID: 35983965 PMCID: PMC9422242 DOI: 10.1097/coc.0000000000000936] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations. MATERIALS AND METHODS We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was compared with pandemic (2020) data. RESULTS Three thousand three sixty one screening chest computed tomography scans (CTs), 35,917 colonoscopies, and 48,093 screening mammograms were performed. There was no difference in CTs [81.0 (SEM10.0) vs. 65.6 (SEM3.29), P =0.067] or mammograms [1017.0 (SEM171.8) vs. 809.4 (SEM56.41), P =0.177] in 2020 versus prepandemic. There were fewer colonoscopies in 2020 [651.4 (SEM103.5) vs. 758.91 (SEM11.79), P =0.043]. There was a decrease in cancer diagnoses per month in 2020 of lung [22.70 (SEM1.469) vs. 28.75 (SEM0.8216), P =0.003] and breast [38.56 (SEM6.133) vs. 51.82 (SEM1.257), P =0.001], but not colorectal [13.11 (SEM1.467) vs. 15.88 (SEM0.585), P =0.074] cancer. There was no change in stage at presentation for lung ( P =0.717), breast ( P =0.115), or colorectal cancer ( P =0.180). Lung had a shorter time-to-treatment in 2020 [38.92 days (SEM 2.48) vs. 66 (SEM1.46), P =0.002]. CONCLUSIONS In 2020, there was no difference in screening studies for lung and breast cancer but there was a decrease in new diagnoses. Although there were fewer colonoscopies performed in 2020, there was no change in new colorectal cancer diagnoses. Despite changes in guidelines during the pandemic, the time-to-treatment for lung cancer was shorter and was unchanged for colorectal and breast cancer. These findings highlight the importance of continuing care for a vulnerable patient population despite a pandemic.
Collapse
|
44
|
Fancellu A, Veneroni S, Santoru A, Meloni A, Sanna V, Ginesu GC, Deiana G, Paliogiannis P, Ninniri C, Perra T, Porcu A. How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview. World J Gastrointest Oncol 2022; 14:1490-1498. [PMID: 36160740 PMCID: PMC9412930 DOI: 10.4251/wjgo.v14.i8.1490] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection. Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC. In fact, the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection. Besides, colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage. Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed, and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population. A systematic review of the literature was performed, including the PubMed, Scopus, Web of Sciences, and Reference Citation Analysis databases, with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy. We found that reduction of CRC screening activity surpassed 50% in most endoscopic units, with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020 vs the same period of 2019. While the consequences of the discontinuation of endoscopy screening for the prognosis and mortality of CRC will be evident in the next few years, recent data confirm that CRC is currently treated at a more advanced stage than in the pre-COVID-19 era. Since delays in CRC prevention and early diagnosis may translate to increased CRC-specific mortality, world healthcare systems should adopt strategies to maintain the regularity of CRC screening during subsequent peaks of the COVID-19 pandemic, or future events that might hamper screening programs.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Simone Veneroni
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Antonio Santoru
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Arianna Meloni
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Giorgio C Ginesu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Giulia Deiana
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical, and Experimental Sciences. Unit of Pathology, University of Sassari, Sassari 07100, Italy
| | - Chiara Ninniri
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Teresa Perra
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Alberto Porcu
- Department of Medical, Surgical, and Experiemental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| |
Collapse
|
45
|
Park H, Seo SH, Park JH, Yoo SH, Keam B, Shin A. The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea. Epidemiol Health 2022; 44:e2022053. [PMID: 35760396 PMCID: PMC9754922 DOI: 10.4178/epih.e2022053] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/21/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening. METHODS Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals. RESULTS The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer). CONCLUSIONS After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.
Collapse
Affiliation(s)
- Hyeree Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea,Cancer Research Institute, Seoul National University, Seoul, Korea,Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hee Seo
- Cancer Research Institute, Seoul National University, Seoul, Korea,Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea,Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Cancer Research Institute, Seoul National University, Seoul, Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea,Cancer Research Institute, Seoul National University, Seoul, Korea,Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea,Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea,Correspondence: Aesun Shin Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
| |
Collapse
|
46
|
COVID-19 Impact on Diagnosis and Staging of Colorectal Cancer: A Single Tertiary Canadian Oncology Center Experience. Curr Oncol 2022; 29:3282-3290. [PMID: 35621658 PMCID: PMC9139669 DOI: 10.3390/curroncol29050268] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Public health measures have imposed drastic reductions in cancer screening programs at the beginning of the COVID-19 pandemic, with an unknown impact on the diagnosis and staging of colorectal cancer (CRC). Methods: Newly diagnosed CRC cases at the Centre Hospitalier de l’Université de Montréal (CHUM) were divided into two groups according to the timeline: pre-pandemic (1 January 2018–12 March 2020), and pandemic (13 March 2020–30 June 2021) periods. Colonoscopy, surgery, and staging at diagnosis during the pandemic period were compared to the pre-pandemic period. Results: 254 CRC diagnoses were made during the pre-pandemic period in comparison to 125 during the pandemic period. Mean diagnosis rates were lower in the pandemic period (7.8 vs. 9.8 diagnoses/month, p = 0.048). Colonoscopy deadlines were less respected in the pandemic period (51.7% vs. 38.3%, p = 0.049). The rate of elective surgery did not differ (2.9 vs. 3.5 surgeries/month, p = 0.39) and mean delays were similar (58.6 vs. 60.4 days, p = 0.77). Stages at diagnosis did not differ (p = 0.17). Most of the delayed colonoscopies led to a stage 0 or I CRC (p = 0.2). Conclusion: In our center, the COVID-19 pandemic resulted in a decreased rate of CRC diagnosis and increased endoscopic delays without affecting the rate of advanced stage disease. Delays to surgery were quite similar once the CRC diagnosis was established.
Collapse
|
47
|
Grad DA, Chereches RM, Strilciuc S, Muresanu D. Scars of stroke care emerge as COVID-19 shifts to an endemic in many countries. J Med Life 2022; 15:589-591. [PMID: 35815080 PMCID: PMC9262269 DOI: 10.25122/jml-2022-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Razvan Mircea Chereches
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin Muresanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
48
|
Concepcion J, Yeager M, Alfaro S, Newsome K, Ibrahim J, Bilski T, Elkbuli A. Trends of Cancer Screenings, Diagnoses, and Mortalities During the COVID-19 Pandemic: Implications and Future Recommendations. Am Surg 2022:31348221091948. [PMID: 35420510 PMCID: PMC9014329 DOI: 10.1177/00031348221091948] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction The impact of the COVID-19 pandemic on cancer screenings and care has yet to
be determined. This study aims to investigate the screening, diagnosis, and
mortality rates of the top five leading causes of cancer mortality in the
United States from 2019 to 2021 to determine the potential impact of the
COVID-19 pandemic on cancer care. Methods A retrospective cohort study investigating the impact of the COVID-19
pandemic on screening, diagnoses, and mortality rates of the top five
leading causes of cancer death (lung/bronchus, colon/rectum, pancreas,
breast, and prostate), as determined by the National Institute of Health
(NIH) utilizing The United States Healthcare Cost Institute and American
Cancer Society databases from 2019 to 2021. Results Screenings decreased by 24.98% for colorectal cancer and 16.01% for breast
cancer from 2019 to 2020. Compared to 2019, there was a .29% increase in
lung/bronchus, 19.72% increase in colorectal, 1.46% increase in pancreatic,
2.89% increase in breast, and 144.50% increase in prostate cancer diagnoses
in 2020 (all P < .01). There was an increase in the total number of
deaths from colorectal, pancreatic, breast, and prostate cancers from 2019
to 2021. Conclusion There was a decrease in the screening rates for breast and colorectal cancer,
along with an increase in the estimated incidence and mortality rate among
the five leading causes of cancer deaths from 2019 to 2021. The findings
suggest that the COVID-19 pandemic is associated with impaired cancer
screening, diagnosis, and care, and further emphasizes the need for
proactive screening and follow-up to prevent subsequent cancer morbidity and
mortality.
Collapse
Affiliation(s)
| | - Matthew Yeager
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Sophie Alfaro
- 390414A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Kevin Newsome
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Joseph Ibrahim
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| |
Collapse
|
49
|
Ribes J, Pareja L, Sanz X, Mosteiro S, Escribà JM, Esteban L, Gálvez J, Osca G, Rodenas P, Pérez-Sust P, Borràs JM. Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery. ESMO Open 2022; 7:100486. [PMID: 35714476 PMCID: PMC9197337 DOI: 10.1016/j.esmoop.2022.100486] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- J Ribes
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain; Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain.
| | - L Pareja
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - X Sanz
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain
| | - S Mosteiro
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - J M Escribà
- Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain; Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - L Esteban
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain
| | - J Gálvez
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - G Osca
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - P Rodenas
- Catalan Electronic Health Record, EHealth Office, Health/Catalan Health Service, Department of Health of Catalonia, Barcelona, Spain
| | - P Pérez-Sust
- CatSalut Information Systems and Health Department ICT Unit, Barcelona, Spain
| | - J M Borràs
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain
| |
Collapse
|
50
|
Varlas VN, Borș RG, Pop AL, Năsui BA, Bacalbasa N, Bohîlțea R, Vlădăreanu R, Manolea C. Oncofertility and COVID-19: At the Crossroads between Two Time-Sensitive Fields. J Clin Med 2022; 11:jcm11051221. [PMID: 35268312 PMCID: PMC8911324 DOI: 10.3390/jcm11051221] [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: 12/19/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background: COVID-19 infection has dominated our lives and left its mark on it. The impact on fertility is major, and the long-term consequences may be disastrous. When we talk about oncofertility, we are talking about those patients worried about the delay in receiving medical services (possible cancelation of surgery, decreased availability of medical services, reorientation of medical resources) due to COVID-19. Finally, patients’ worsening biological and reproductive statuses, associated with high levels of anxiety and depression, are closely related to social restrictions, economic impact, reorientation of medical resources, health policies, and fears of SARS-CoV-2 infection. Aim: We reviewed the current literature on fertility during the COVID-19 pandemic and its effect on cancer patients. Specifically, how cancer treatment can affect fertility, the options to maintain fertility potential, and the recovery options available after treatment are increasingly common concerns among cancer patients. Methods: A systematic literature search was conducted using two main central databases (PubMed®/MEDLINE, and Web of Science) to identify relevant studies using keywords SARS-CoV-2, COVID-19, oncofertility, young cancer patient, cryopreservation, assisted reproductive techniques (ART), psychosocial, telemedicine. Results: In the present study, 45 papers were included, centered on the six main topics related to COVID-19. Conclusions: Fertility preservation (FP) should not be discontinued, but instead practiced with adjustments to prevent SARS-CoV-2 transmission. The increased risk of SARS-CoV-2 infection in cancer patients requires screening for COVID-19 before FP procedures, among both patients and medical staff in FP clinics, to prevent infection that would rapidly worsen the condition and lead to severe complications.
Collapse
Affiliation(s)
- Valentin Nicolae Varlas
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Correspondence: (R.G.B.); (R.B.)
| | - Anca Lucia Pop
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Clinical Laboratory, Food Safety, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Bogdana Adriana Năsui
- Department of Community Health, Iuliu Hațieganu University of Medicine and Pharmacy, 6 Louis Pasteur Street, 400349 Cluj-Napoca, Romania;
| | - Nicolae Bacalbasa
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Cantacuzino Clinical Hospital, 030167 Bucharest, Romania
| | - Roxana Bohîlțea
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Correspondence: (R.G.B.); (R.B.)
| | - Radu Vlădăreanu
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynecology, Elias Clinical Hospital, 17 Mărăști Blvd., 011461 Bucharest, Romania
| | - Corina Manolea
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Assisted Reproduction Department, Columna Medical Center, 021522 Bucharest, Romania
| |
Collapse
|