Interruption of cancer screening services due to COVID-19 pandemic: lessons from previous disasters

Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches

BACKGROUND

The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined.

OBJECTIVE

To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018-2019) with the phase following the pandemic's second wave (2021-2022).

METHODS

An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data.

RESULTS

More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021-2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018-2019 and two in 2021-2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55-8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09-3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44-7.17, p = 0.004).

CONCLUSIONS

Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.

A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations

This review article highlights the critical role of nurses in disaster management, with a specific focus on addressing blood tumors in disaster-affected populations. Disasters have a significant impact on healthcare systems and populations, and nurses play a crucial role in disaster preparedness, response, and recovery. The article provides case studies and successful examples of nursing interventions in disaster settings and tumor management, emphasizing the challenges and opportunities in providing cancer care in disaster settings. Recommendations for future research and practice in disaster nursing and blood tumor care are also presented. This information is essential for healthcare professionals and policymakers involved in disaster management, as well as researchers and clinicians working in the field of cancer care.

The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania

Introduction

The COVID-19 pandemic had a significant impact on the healthcare system, leading to a prioritization of hospital admissions in many countries. Romania was no exception, and it had to restrict patient access to medical services in hospitals with chronic diseases and oncological pathology, including thyroid cancer. This study aimed to compare the clinical and pathological factors of patients with nodular thyroid disease diagnosed and surgically treated during the two years before and after the COVID-19 pandemic, in a single medical institution.

Methods

The retrospective study included 1505 patients who were diagnosed and operated on for nodular thyroid disease between January 2018 and December 2021. The patients were divided into two groups: the "PRECOVID" group (January 2018 to February 2020), and the "POSTCOVID" group (March 2020 to December 2021). The analyzed parameters included patients' gender, age, preoperative diagnosis, type of surgical intervention, and pathological diagnosis.

Results

A significant decrease was observed in the number of surgeries performed for thyroid nodular disease during the COVID-19 pandemic period (450 versus 1055 cases, p<0.00001). There was a significant decrease in the number of surgical reinterventions (0.9% in the POSTCOVID group versus 2.9% in the PRECOVID group, p=0.01) and a significant increase in the number of total thyroidectomies (84.9% in the POSTCOVID group versus 80.1% in the PRECOVID group, p=0.02). We also observed a higher incidence of malignant/borderline tumors in the POSTCOVID group compared to the PRECOVID group (p=0.04) and a significantly higher frequency of aggressive forms of thyroid cancer in the POSTCOVID group (p=0.0006).

Discussion

The COVID-19 pandemic had a significant impact on the surgical management of nodular thyroid disease, resulting in a decrease in surgeries and a change in the type of surgical interventions performed. The higher incidence of malignant/borderline tumors diagnosed during the pandemic highlights the importance of timely diagnosis and treatment of thyroid nodules to prevent cancer progression.

Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France

IMPORTANCE

COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period.

OBJECTIVE

To examine approaches that may better assess the use of cancer surgeries.

DESIGN, SETTING, AND PARTICIPANTS

In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021.

EXPOSURE

Estimated cancer surgery activity during the COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES

Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years.

RESULTS

In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.

Global Association of COVID-19 Pandemic Measures With Cancer Screening: A Systematic Review and Meta-analysis

Importance

Public health services, including cancer screening tests, have been affected by the onset of the COVID-19 epidemic.

Objective

To investigate the pandemic's association with cancer screening worldwide.

Data Sources

In this systematic review and meta-analysis, databases such as PubMed, ProQuest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021.

Study Selection

Observational studies and articles that reported data from cancer registries that compared the number of screening tests performed before and during the pandemic for breast, cervical, and colorectal cancer were included.

Data Extraction and Synthesis

Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage variation was calculated between the 2 periods to assess the change in the number of cancer screening tests performed during the pandemic. Stratified analysis was performed by geographic area, period, and type of setting. The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main Outcomes and Measures

The main outcome was the weighted average percentage variation in the number of screening tests performed between January and October 2020 compared with the previous period.

Results

The review comprised 39 publications. There was an overall decrease of -46.7% (95% CI, -55.5% to -37.8%) for breast cancer screening, -44.9% (95% CI, -53.8% to -36.1%) for colorectal cancer screening, and -51.8% (95% CI, -64.7% to -38.9%) for cervical cancer screening during the pandemic. For all 3 cancers, a U-shaped temporal trend was identified; for colorectal cancer, a significant decrease was still apparent after May 2020 (in June to October, the decrease was -23.4% [95% CI, -44.4% to -2.4%]). Differences by geographic area and screening setting were also identified.

Conclusions and Relevance

A summary estimate of the downscaling of cancer screening tests since the onset of the COVID-19 pandemic is provided in this systematic review and meta-analysis. This could be associated with an increase in the number of avoidable cancer deaths. Effective interventions are required to restore the capacity of screening services to the prepandemic level.

A Review of Cancer Screening Recommendations during the COVID-19 Pandemic

BACKGROUND

Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the utilization of preventive health care services. While there was a rise in the number of cancer screening tests beginning in late 2020, screenings remained 29%-36% lower than in the pre-pandemic era.

OBJECTIVE

The objective of this review article was to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic.

METHODS

We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. Literature review ranged from January 1st, 2020 to September 30th, 2021.

RESULTS

The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, of certain age group and sex, having personal medical or family history of cancers, currently symptomatic, predisposed to hereditary cancers, and cancer-causing mutations. Other recommended strategies included: identifying areas facing most disparities, creating algorithms and using artificial intelligence to create cancer-risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening-eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods which do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers and implementing or expanding mobile screening units.

CONCLUSIONS

Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and under-resourced areas after the pandemic has ended.

CLINICALTRIAL

Online public interest in common malignancies and cancer screening during the COVID-19 pandemic in the United States

BACKGROUND AND AIM

The COVID-19 pandemic was declared a national emergency in the United States in March 2020. The Centers for Medicare and Medicaid Services subsequently released recommendations that health-care facilities temporarily delay elective surgeries and non-essential medical procedures. Disruptions to medical care significantly impacted cancer patients, with cancer screenings halted and nonurgent cancer surgeries postponed as health-care facilities shifted resources toward the COVID-19 pandemic. Although it has been reported that cancer screening rates decreased dramatically in the United States in 2020, it is unclear whether this trend was driven by factors related to public interest in cancer and/or cancer screening as opposed to other factors such as clinical backlogs, pandemic-related policies, and/or resource limitations. The purpose of this study was to use the Google Trends tool to evaluate public interest in six common malignancies and four common cancer screening methods during the COVID-19 pandemic.

METHODS

We used the Google Trends tool to quantify public interest in six different malignancies (Breast Cancer, Colon Cancer, Lung Cancer, Prostate Cancer, Thyroid Cancer, and Cervical Cancer) and four cancer screening methods (Pap Smear, Lung Cancer Screening, Mammogram, and Colonoscopy) in the United States during the COVID-19 pandemic. Welch's t-tests were used to compare monthly search volumes during the COVID-19 pandemic (2020) to the 4 years before the pandemic (2016 - 2019) for all ten search terms included in our study. We used Benjamini-Hochberg to adjust raw p values to account for multiple statistical comparisons. The level of statistical significance was defined by choosing a false discovery rate of 0.05.

RESULTS

Our results indicate significantly reduced interest in all malignancies studied at the beginning of the COVID-19 pandemic. Public interest in ['Breast Cancer'], ['Colon Cancer'], ['Lung Cancer'], ['Thyroid Cancer'], and ['Cervical Cancer'] significantly decreased in the months of March, April, May, and June 2020 when compared with public interest in 2016-2019. Public interest in cancer screening methods such as ['Pap Smear'], ['Lung Cancer Screening'], ['Mammogram'], and ['Colonoscopy'] significantly deceased in the months of April and May compared to 2016 - 2019 values. However, decreased public interest in cancer screening methods was temporary, with Google search volumes returning to pre-pandemic levels in June 2020 - December 2020.

CONCLUSION

There was significantly reduced public interest in both common malignancies and cancer screening methods at the beginning of the COVID-19 pandemic in the United States. However, after an initial decline, public interest as indicated by Google search volumes quickly returned to pre-pandemic levels in the second half of the calendar year 2020. In addition, trends in public interest in cancer screening as indicated by Google search volumes aligned with cancer screening uptake rates in the United States during the study period. This finding suggests that Google Trends may serve as an effective tool in gauging the public's interest in cancer and/or cancer screenings in the United States, which makes it a valuable resource that can be used to inform decisions aimed at improving cancer screening rates in the future.

RELEVANCE FOR PATIENTS

The Google Trends tool can be used to measure public interest in various malignancies and their associated screening methods. Google Trends data may be used to inform measures aimed at improving cancer screening uptake.

Early assessment of the first wave of the COVID-19 pandemic on cancer screening services: The International Cancer Screening Network COVID-19 survey

Screening can decrease the burden of breast, cervical, and colorectal cancers. The COVID-19 pandemic led many countries to suspend cancer screening services as part of their response to the pandemic. The International Cancer Screening Network (ICSN) carried out an online survey to assess the effects of the first wave of the COVID-19 pandemic on cancer screening. A 33-item survey was distributed to 834 email addresses to gather information about settings and assess decision-making processes that led to cancer screening suspension. Information about communication, impact on resources, and patient follow-up was collected. Quantitative data was analyzed as frequencies overall and by setting, while a comment section under each survey item captured nuanced details. Responses were recategorized into 66 settings, representing 35 countries. Most settings suspended cancer screening services (n = 60, 90.9%) in March 2020 (n = 45, 68.2%), guided by a government decision (n = 51, 77.3%). Few settings made the decision whether to suspend services based on a preparedness plan (n = 17, 25.8%). In most settings, professionals were reassigned (n = 41, 62.1%) and infrastructure repurposed (n = 35, 53.0%). The first wave of the COVID-19 pandemic has had profound effects on cancer screening worldwide, including the suspension of services in almost all settings. Most settings were unprepared to deal with the scale of the pandemic but demonstrated flexibility in the response. These results contribute to inform, through experiences and lessons learned, the next steps for the global cancer screening community to further evaluate the impact of COVID-19 and prepare for future disruptions.