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Huang WL, Liao SL, Huang HL, Tsai PJ, Huang HH, Lu CY, Ho WS. Impact of post-COVID-19 changes in outpatient chronic patients' healthcare-seeking behaviors on medical utilization and health outcomes. HEALTH ECONOMICS REVIEW 2024; 14:71. [PMID: 39235715 PMCID: PMC11376019 DOI: 10.1186/s13561-024-00553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/30/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION This study comprehensively investigates the changes in healthcare utilization among chronic patients with regular outpatient visits to hospitals after the occurrence of Covid-19. The research examines whether patients altered their originally regular medical attendance frequencies due to the pandemic and explores potential negative impacts on the health conditions of those irregular attendees post-pandemic. METHODS Data for this study were sourced from a database at a medical center in Taiwan. The subjects were chronic patients with regular hospital outpatient visits before the Covid-19 outbreak. The study tracked medical utilization patterns from 2017 to 2022 for different patient characteristics and outpatient behaviors, employing statistical methods such as Repeated Measures ANOVA and Generalized Estimating Equation to analyze changes in healthcare utilization and health status during the post-pandemic period. RESULTS The results reveal that, compared to the regular group, chronic patients with irregular outpatient visits during the post-pandemic period exhibited a decrease of 5.85 annual outpatient visits, a reduction of NT$20,290.1 in annual medical expenses, and a significantly higher abnormality rate in average biochemical test results by 0.9%. CONCLUSIONS The findings contribute to understanding the impact of the Covid-19 pandemic on healthcare utilization and health conditions among outpatient chronic disease populations. In response to the new medical landscape in the post-pandemic era, proactive suggestions are made, including providing telemedicine outpatient services and referral-based medical care to meet the needs of the target population, ensuring a continuous and reassuring healthcare model for chronic patients, and mitigating the operational impacts of public health emergencies on hospitals.
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Affiliation(s)
- Wei-Lun Huang
- Medical Affairs Office, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
- Department of Industrial Education and Technology, National Changhua University of Education, Bao-Shan Campus, No.2, Shi-Da Rd, Changhua City, 500208, Taiwan
- Department of Health Services Adminstration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan
| | - Shu-Lang Liao
- Medical Affairs Office, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
- College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist, Taipei City, 100233, Taiwan
| | - Hsueh-Ling Huang
- Medical Affairs Office, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
| | - Pei-Ju Tsai
- Medical Affairs Office, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
| | - Hsin-Hsun Huang
- Medical Affairs Office, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist, Taipei City, 100225, Taiwan
| | - Chien-Yu Lu
- Department of Industrial Education and Technology, National Changhua University of Education, Bao-Shan Campus, No.2, Shi-Da Rd, Changhua City, 500208, Taiwan
| | - Wei-Sho Ho
- Department of Industrial Education and Technology, National Changhua University of Education, Bao-Shan Campus, No.2, Shi-Da Rd, Changhua City, 500208, Taiwan.
- NCUE Alumni Association, National Changhua University of Education, Jin-De Campus, No. 1, Jinde Rd., Changhua City, 500207, Taiwan.
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Bravo L, Vizcarra K, Zavaleta J, Paez KJ, Morante Z, Limache-García A, Saravia CH. Impact of the COVID-19 Pandemic on the Treatment of Cancer Patients at a Hospital in Peru. Cancer Control 2024; 31:10732748241276616. [PMID: 39155527 PMCID: PMC11331466 DOI: 10.1177/10732748241276616] [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: 05/01/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND The appearance of the new coronavirus, SARS-CoV-2, in Wuhan - China, in 2019 led to the declaration of a COVID-19 pandemic by the World Health Organization. Peru confirmed its first case on March 6, 2020, prompting a significant change in medical care. PURPOSE Our objective was to determine the impact of the COVID-19 pandemic on cancer treatment in Peru. METHODS A retrospective analysis of hospital data from the National Institute of Neoplastic Diseases revealed substantial decreases in oncological treatments in 2020 compared to 2019. RESULTS Oncological treatments involving bone marrow transplantation had a greater impact between the months of April and September, at -100% (p=0.003). However, treatments involving surgery in April (-95% [p≤0.001]), radiotherapy in May (-76% [p=0.002]) and chemotherapy in June (-71% [p≤0.001]) also showed significant impacts. Comparative analysis with international data revealed similar trends in cancer care interruptions in different countries. However, variations in the magnitude of the impact were observed, influenced by regional health policies and the severity of the pandemic. CONCLUSIONS The findings underscore the challenges cancer care providers face during public health crises, requiring adaptive strategies to ensure continued access to essential treatments. Addressing these challenges requires comprehensive public health responses to mitigate the impact of future crises on cancer care systems.
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Affiliation(s)
- Leny Bravo
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Karla Vizcarra
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Jenny Zavaleta
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Kevin J. Paez
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Perú
| | - Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
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Silverio-Murillo A, Hoehn-Velasco L, Balmori de la Miyar J, Méndez Méndez JS. The COVID-19 pandemic and non-COVID-19 healthcare utilization in Mexico. Public Health 2024; 226:99-106. [PMID: 38042128 DOI: 10.1016/j.puhe.2023.10.039] [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: 03/21/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES This study aimed to analyze the effects of the COVID-19 pandemic on non-COVID-19 healthcare utilization in Mexico, including oral health, mental health, communicable disease visits, health checkups, chronic degenerative disease visits, postpartum care, prenatal care, and family planning visits. STUDY DESIGN This was a retrospective ecological analysis during the COVID-19 pandemic. During the pandemic, the Mexican government recommended non-essential consultations be suspended or rescheduled to accommodate the new demand for healthcare services from COVID-19 patients. METHODS This study uses administrative data from Mexico's Ministry of Health from January 2017 to December 2022. These data cover 14,299 consultation units and 775 hospitals from the 32 Mexican States, all of which are public institutions. A difference-in-differences strategy and an event study specification are used to study the impacts of the pandemic on non-COVID-19 healthcare utilization. RESULTS The findings reveal a decrease in the utilization of all healthcare services: oral health (69%), mental health (27%), communicable diseases (46%), chronic degenerative diseases (36%), health checkups (62%), family planning (45%), prenatal care (36%), and postpartum care (44%). Furthermore, the event study indicates that most services follow a U-shaped trend, although only mental health services clearly return to prepandemic levels. The remainder of services remain below prepandemic levels at the end of 2022. CONCLUSIONS The 2020 pandemic had detrimental effects on non-COVID-19 healthcare utilization. The healthcare interruptions will likely impact short- and long-term morbidity and mortality. Programs intended to remediate these negative consequences may be of interest to public health policymakers.
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Affiliation(s)
| | - L Hoehn-Velasco
- Andrew Young School of Policy Studies, Georgia State University, USA.
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Omidifar N, Pazoki N, Shokripour M, Fattahi MR, Safarpour AR, Fallahzadeh Abarghooee E, Nikmanesh N, Shamsdin SA, Akrami H, Saghi SA, Nikmanesh Y. The Effect of Coronavirus Disease 2019 on the Quality of Associated Care in Patients with Gastric Cancer. Middle East J Dig Dis 2024; 16:12-22. [PMID: 39050096 PMCID: PMC11264831 DOI: 10.34172/mejdd.2024.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/09/2023] [Indexed: 07/27/2024] Open
Abstract
Coronavirus is a new virus that has affected human life on a large scale; it has infected millions of people and killed hundreds of thousands of people. In contrast, among cancers, stomach neoplasia is the most common cancer of the upper gastrointestinal (UGI) tract. COVID-19 disease has disrupted the optimal management of patients with cancer. Metastasis, deterioration of the patient's nutritional status, UGI bleeding, and increased surgical complications are all consequences of delayed treatment of patients with gastric cancer. However, there is still insufficient evidence on the immunogenicity of the vaccine and the protection provided by coronavirus vaccines in patients with cancer, especially those with immunodeficiency or those who are treated for certain types of cancers. Also, as part of the prevention and control of COVID-19 disease, nutritional support for patients with gastrointestinal cancer is particularly important, and the psychological and physiological limitations caused by the disease duration are hurting the well-being of patients. Therefore, the assessment of the impact of the coronavirus on cancer should be treated as an important issue, and healthcare professionals should be prepared to deal with the long-term effects of the coronavirus disease.
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Affiliation(s)
- Navid Omidifar
- Biotechnology Research Center and Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Pazoki
- Department of Genetics, Faculty of Biological Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mansoureh Shokripour
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nika Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Azra Shamsdin
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Akrami
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Amirreza Saghi
- Cellular and Molecular Biology Research Center, Larestan University of Medical Sciences, Larestan, Iran
- Student Research Committee, Larestan University of Medical Sciences, Larestan, Iran
| | - Yousef Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Durán D, Anyosa RC, Nicolau B, Kaufman JS. Uncovering the impact of COVID-19 on the place of death of cancer patients in South America. CAD SAUDE PUBLICA 2023; 39:e00057423. [PMID: 38055544 DOI: 10.1590/0102-311xen057423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/29/2023] [Indexed: 12/08/2023] Open
Abstract
The COVID-19 pandemic has significantly impacted healthcare systems worldwide, especially on the management of chronic diseases such as cancer. This study explores the effects of COVID-19 on cancer mortality trends in Brazil, Chile, and Peru. The monthly age-standardized mortality rates in different places of death (hospital/clinic or home) were estimated using vital statistics and death certificate databases. An interrupted time series analysis was performed for each country, using the date of lockdown implementation as the intervention point. Overall cancer mortality rates reduced after the implementation of pandemic restrictions, with a significant decrease in Brazil. In total, 75.3%, 55.4%, and 45.7% of deaths in Brazil, Peru, and Chile, respectively, occurred in hospitals. After lockdowns were implemented, at-home deaths increased in all countries, and in-hospital deaths correspondingly decreased only in Chile. Our results suggest that COVID-19 has significantly affected rates of cancer mortality and place of death in Latin America.
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Affiliation(s)
- Doris Durán
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | | | - Jay S Kaufman
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Ivanov N, Krastev B, Miteva DG, Batselova H, Alexandrova R, Velikova T. Effectiveness and safety of COVID-19 vaccines in patients with oncological diseases: State-of-the-art. World J Clin Oncol 2023; 14:343-356. [PMID: 37771630 PMCID: PMC10523189 DOI: 10.5306/wjco.v14.i9.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/06/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
Although the coronavirus disease 2019 (COVID-19) pandemic was declared to be no longer “a public health emergency of international concern” with its wide range of clinical manifestations and late complications, severe acute respiratory syndrome coronavirus 2 infection proved to be a serious threat, especially to the elderly and patients with comorbidities. Patients with oncologic diseases are vulnerable to severe infection and death. Indeed, patients with oncohematological diseases have a higher risk of severe COVID-19 and impaired post-vaccination immunity. Unfortunately, cancer patients are usually excluded from vaccine trials and investigations of post-vaccinal immune responses and the effectiveness of the vaccines. We aimed to elucidate to what extent patients with cancer are at increased risk of developing severe COVID-19 and what is their overall case fatality rate. We also present the current concept and evidence on the effectiveness and safety of COVID-19 vaccines, including boosters, in oncology patients. In conclusion, despite the considerably higher mortality in the cancer patient group than the general population, countries with high vaccination rates have demonstrated trends toward improved survival of cancer patients early and late in the pandemic.
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Affiliation(s)
- Nedelcho Ivanov
- Department of Clinical Immunology with Stem Cell Bank, University Hospital Alexanrovska, Sofia 1431, Bulgaria
| | - Boris Krastev
- Medical Center Nadezhda, Medical Center Nadezhda, Sofia 1407, Bulgaria
| | | | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University, Plovdiv, University Hospital St. George, Plovdiv 6000, Bulgaria
| | - Radostina Alexandrova
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia 1000, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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Herrera CA, Kerr AC, Dayton JM, Kakietek JJ. Healthcare service disruption in 14 Latin American and Caribbean countries during the COVID-19 pandemic: Analysis of household phone surveys, 2020-2021. J Glob Health 2023; 13:06023. [PMID: 37469284 PMCID: PMC10359759 DOI: 10.7189/jogh.13.06023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Background The coronavirus 2019 (COVID-19 pandemic) and associated responses have significantly disrupted healthcare. We aimed to estimate the magnitude of and reasons for households reporting healthcare disruption in 14 Latin America and the Caribbean (LAC) region countries from mid-2020 to mid-2021, and its relationship with country contextual factors. Methods We used COVID-19 high-frequency phone surveys (HFPS) conducted in 14 LAC countries in three rounds in 2020 and one in 2021. We classified the reasons reported for healthcare disruption into four groups: concerns about contracting COVID-19, healthcare supply constraints, financial reasons, and public health measures (PHMs). We used bivariate and multivariate regressions to examine correlates of reported healthcare disruption with the above groups and country context as control variables. Results On average, 20% of households reported a disruption in May-June 2020 (45% to 10% at country level), dropping to 9% in June-July 2020 (31% to 3%) and July-August 2020 (26% to 3%), and declining to 3% in May-July 2021 (11% to 1%). The most common reason reported for disruption was healthcare supply constraints, followed by concerns about contracting COVID-19, PHM, and financial reasons. In multivariable regression analyses, we found that a higher incidence of new COVID-19 cases (regression coefficient (β) = 0.018, P < 0.01), stricter PHM (β = 0.002, P < 0.01), fewer hospital beds per population (β = -0.011, P < 0.01), and lower out-of-pocket health spending (β = -0.0008, P < 0.01) were associated with higher levels of disrupted care. A higher care disruption was associated with a lower gross domestic product (GDP) per person (β = -0.00001, P < 0.01) and lower population density (β = -0.056, P < 0.01). Conclusions Healthcare services for households in LAC were substantially disrupted during the COVID-19 pandemic. Findings about supply and financial constraints can inform the recovery of postponed healthcare services, while public health and contextual factors findings can inform future health system resilience efforts in LAC and elsewhere.
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Affiliation(s)
- Cristian A Herrera
- World Bank, Washington DC, District of Columbia, USA
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Amanda C Kerr
- Department of Economics, University of Maryland, College Park, Maryland, USA
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LaRotta J, Escobar O, Ávila-Aguero ML, Torres JP, Sini de Almeida R, Morales GDC, Srivastava A. COVID-19 in Latin America: A Snapshot in Time and the Road Ahead. Infect Dis Ther 2023; 12:389-410. [PMID: 36633818 PMCID: PMC9835740 DOI: 10.1007/s40121-022-00748-z] [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: 09/02/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
Since its initial detection in Brazil in February 2020, SARS-CoV-2 and the associated COVID-19 pandemic have continued to devastate Latin America. Specific comorbidities, as well as sociodemographic and lifestyle factors that may be more prevalent in underserved areas, have been identified as risk factors for COVID-19 infection or associated adverse outcomes. Dynamics of infections and deaths in Latin America have varied by country and temporally, as has SARS-CoV-2 variant prevalence; however, more recently, the Delta and subsequent Omicron variants have become ubiquitous. Successful pandemic responses have involved robust infection mitigation measures, testing, and smart deployment of healthcare resourcing. While in some Latin American countries up to 90% of the population is fully vaccinated (i.e., 2 doses) against COVID-19, other countries have failed to reach the World Health Organization's 70% target. Continued focus on comprehensive surveillance, strategies to maximize vaccine availability and uptake, and mitigation of collateral damage on other aspects of public health and social services are critical for managing the COVID-19 pandemic. This review summarizes the COVID-19 experience in Latin America, including epidemiology and vaccination. Key learnings and future considerations for the ongoing pandemic response are also discussed.
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Affiliation(s)
- Jorge LaRotta
- Vaccines Medical and Scientific Affairs, Pfizer SAS, AV Suba 95-66, Bogotá, Colombia.
| | - Omar Escobar
- Vaccines Medical and Scientific Affairs, Pfizer SAS, AV Suba 95-66, Bogotá, Colombia
| | - María L Ávila-Aguero
- Pediatric Infectious Diseases, Hospital Nacional de Niños, San José, Costa Rica
- Center for Infectious Disease Modeling and Analysis, Yale University, New Haven, CT, USA
| | - Juan Pablo Torres
- Departamento de Pediatría y Cirugía Infantil Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | | | - Amit Srivastava
- Vaccines, Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Cambridge, MA, USA
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Allahqoli L, Mazidimoradi A, Salehiniya H, Alkatout I. Impact of COVID-19 on cancer screening: a global perspective. Curr Opin Support Palliat Care 2022; 16:102-109. [PMID: 35862881 PMCID: PMC9451605 DOI: 10.1097/spc.0000000000000602] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cancer screening disruption due to COVID-19 may have a significant impact on patients, healthcare practitioners, and healthcare systems. In this present review, we aim to offer a comprehensive view of the effect of the COVID-19 pandemic on cancer screening programs worldwide. RECENT FINDINGS The present review comprised 33 publications. During the COVID-19 pandemic, the rates of cancer screening investigations were drastically reduced worldwide. Screening rates plummeted for all types of cancer, all ages, and racial/ethnic groups. Reductions in screening percentages were higher in several underserved racial groups. Cancer screening was suspended for at least 30 days in 13 countries. SUMMARY Screenings for all types of cancer fell sharply. In the chain of cancer management, delays in any step are liable to change the outcome of the next step. Further long-term research will be needed to fully comprehend the impact of the pandemic on cancer services and patient outcomes.
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Affiliation(s)
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Kiel, Germany
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Cuadrado C, Vidal F, Pacheco J, Flores-Alvarado S. Acceso a la atención del cáncer en los grupos vulnerables de Chile durante la pandemia de COVID-19. Rev Panam Salud Publica 2022; 46:e77. [PMID: 35990523 PMCID: PMC9384893 DOI: 10.26633/rpsp.2022.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objetivo.
Estudiar la repercusión de la pandemia de COVID-19 en el acceso a la atención del cáncer en Chile, analizando los efectos diferenciales por tipo de seguro, sexo y edad.
Métodos.
Se llevó a cabo un estudio cuasiexperimental mediante análisis de series temporales interrumpidas. Se recurrió a fuentes de datos múltiples con el fin de lograr una evaluación amplia de la utilización de la atención del cáncer de enero del 2017 a diciembre del 2020. Se ajustaron modelos binomiales negativos en función de los grupos de población para una diversidad de servicios y diagnósticos.
Resultados.
Tras una disminución considerable de la utilización de la atención oncológica en marzo, se observó una recuperación lenta e incompleta durante el 2020. Los servicios de atención del cáncer, las confirmaciones diagnósticas y las licencias por enfermedad acumulados se redujeron en un tercio en el 2020; la disminución fue más pronunciada en las mujeres y las personas afiliadas al seguro de enfermedad público. No se hizo un diagnóstico temprano en 5132 personas con cuatro tipos frecuentes de cáncer.
Conclusiones.
La pandemia sobrecargó el sistema de salud chileno y provocó una disminución del acceso a los servicios básicos, con una repercusión profunda en la atención del cáncer. La reducción de los servicios de oncología precedió los confinamientos a gran escala y las interrupciones por parte de los prestadores. Cabe destacar que no todos los grupos de la población se vieron afectados por igual y se observaron pautas que indican un agravamiento de las desigualdades por situación socioeconómica y sexo.
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Affiliation(s)
- Cristóbal Cuadrado
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Francisca Vidal
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Jorge Pacheco
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Sandra Flores-Alvarado
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
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Cuadrado C, Vidal F, Pacheco J, Flores-Alvarado S. Cancer Care Access in Chile's Vulnerable Populations During the COVID-19 Pandemic. Am J Public Health 2022; 112:S591-S601. [PMID: 35977338 PMCID: PMC9382144 DOI: 10.2105/ajph.2021.306587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods. We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results. A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions. The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated. (Am J Public Health. 2022;112(S6):S591-S601. https://doi.org/10.2105/AJPH.2021.306587).
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Affiliation(s)
- Cristóbal Cuadrado
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Francisca Vidal
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Jorge Pacheco
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Sandra Flores-Alvarado
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
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Pefaur J, Toro L, Lorca E, Torres R. Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities. Transplantation 2022; 106:680-684. [PMID: 34759256 PMCID: PMC8942594 DOI: 10.1097/tp.0000000000004001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jacqueline Pefaur
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Barros Luco Trudeau, Santiago, Chile
- Division of Nephrology, Clinica Santa Maria, Santiago, Chile
| | - Luis Toro
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile
- Centro de Investigacion Clinica Avanzada, Hospital Clinico Universidad de Chile, Santiago, Chile
- Critical Care Center, Clinica Las Condes, Santiago, Chile
| | - Eduardo Lorca
- Chilean Society of Nephrology, Providencia, Chile
- Departamento de Medicina Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Division of Nephrology, Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago, Chile
| | - Ruben Torres
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Ward ZJ, Walbaum M, Walbaum B, Guzman MJ, Jimenez de la Jara J, Nervi B, Atun R. Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis. Lancet Oncol 2021; 22:1427-1437. [PMID: 34487693 PMCID: PMC8415898 DOI: 10.1016/s1470-2045(21)00426-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic has strained health system capacity worldwide due to a surge of hospital admissions, while mitigation measures have simultaneously reduced patients' access to health care, affecting the diagnosis and treatment of other diseases such as cancer. We estimated the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to inform policies and planning to mitigate the forthcoming cancer-related health impacts of the pandemic in Chile. METHODS We developed a microsimulation model of five cancers in Chile (breast, cervix, colorectal, prostate, and stomach) for which reliable data were available, which simulates cancer incidence and progression in a nationally representative virtual population, as well as stage-specific cancer detection and survival probabilities. We calibrated the model to empirical data on monthly detected cases, as well as stage at diagnosis and 5-year net survival. We accounted for the impact of COVID-19 on excess mortality and cancer detection by month during the pandemic, and projected diagnosed cancer cases and outcomes of stage at diagnosis and survival up to 2030. For comparison, we simulated a no COVID-19 scenario in which the impacts of COVID-19 on excess mortality and cancer detection were removed. FINDINGS Our modelling showed a sharp decrease in the number of diagnosed cancer cases during the COVID-19 pandemic, with a large projected short-term increase in future diagnosed cases. Due to the projected backlog in diagnosis, we estimated that in 2021 there will be an extra 3198 cases (95% uncertainty interval [UI] 1356-5017) diagnosed among the five modelled cancers, an increase of nearly 14% compared with the no COVID-19 scenario, falling to a projected 10% increase in 2022 with 2674 extra cases (1318-4032) diagnosed. As a result of delayed diagnosis, we found a worse stage distribution for detected cancers in 2020-22, which is estimated to lead to 3542 excess cancer deaths (95% UI 2236-4816) in 2022-30, compared with the no COVID-19 scenario, among the five modelled cancers, most of which (3299 deaths, 2151-4431) are projected to occur before 2025. INTERPRETATION In addition to a large projected surge in diagnosed cancer cases, we found that delays in diagnosis will result in worse cancer stage at presentation, leading to worse survival outcomes. These findings can help to inform surge capacity planning and highlight the importance of ensuring appropriate health system capacity levels to detect and care for the increased cancer cases in the coming years, while maintaining the timeliness and quality of cancer care. Potential delays in treatment and adverse impacts on quality of care, which were not considered in this model, are likely to contribute to even more excess deaths from cancer than projected. FUNDING Harvard TH Chan School of Public Health. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard University, Boston, MA, USA.
| | - Magdalena Walbaum
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Benjamin Walbaum
- Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Jorge Jimenez de la Jara
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rifat Atun
- Department of Global Health and Population, Harvard University, Boston, MA, USA; Harvard TH Chan School of Public Health, and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
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Anticipating the COVID-19-related surge in cancer care demand is urgent in Latin America and the Caribbean. Lancet Oncol 2021; 22:1350-1352. [PMID: 34487692 PMCID: PMC8415896 DOI: 10.1016/s1470-2045(21)00484-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
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Mafra da Costa A, Ribeiro AL, Ribeiro AG, Gini A, Cabasag C, Reis RM, Fregnani JHTG, Soerjomataram I. Impact of COVID-19 Pandemic on Cancer-Related Hospitalizations in Brazil. Cancer Control 2021; 28:10732748211038736. [PMID: 34406894 PMCID: PMC8377310 DOI: 10.1177/10732748211038736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Alongside the SARS-CoV-2 (COVID-19) pandemic, Brazil also faces an ongoing rise in cancer burden. In 2020, there were approximately 592 000 new cancer cases and 260 000 cancer deaths. Considering the heterogeneities across Brazil, this study aimed to estimate the impact of the COVID-19 pandemic on cancer-related hospital admissions at a national and regional level. METHODS The national, regional, and state-specific monthly average of cancer-related hospital admission rates per 100 000 inhabitants and 95% confidence intervals (95% CIs) were calculated from March to July (2019: pre-COVID-19; and 2020: COVID-19 period). Thematic maps were constructed to compare the rates between periods and regions. RESULTS Cancer-related hospital admissions were reduced by 26% and 28% for clinical and surgical purposes, respectively. In Brazil, the average hospitalization rates decreased from 13.9 in 2019 to 10.2 in 2020 per 100,000 inhabitants, representing a rate difference of -3.7 (per 100,000 inhabitants; 95% CI: -3.9 to -3.5) for cancer-related (clinical) hospital admissions. Surgical hospital admissions showed a rate decline of -5.8 per 100,000 (95% CI: -6.0 to -5.5). The reduction in cancer-related admissions for the surgical procedure varies across regions ranging between -2.2 and -10.8 per 100 000 inhabitants, with the most significant decrease observed in the south and southeastern Brazil. CONCLUSIONS We observed a substantial decrease in cancer-related hospital admissions during the COVID-19 pandemic with marked differences across regions. Delays in treatment may negatively impact cancer survival in the future; hence, cancer control strategies to mitigate the impact are needed.
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Affiliation(s)
- Allini Mafra da Costa
- Population-based Cancer Registry of Barretos Region, Barretos Cancer Hospital, São Paulo, Brazil,Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France,Allini Mafra da Costa, Cancer Surveillance Branch, International Agency for Research on Cancer, 150, cours Albert Thomas, F-69372 Lyon Cedex 08, France.
| | - Aline L. Ribeiro
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adeylson G. Ribeiro
- Population-based Cancer Registry of Barretos Region, Barretos Cancer Hospital, São Paulo, Brazil
| | - Andrea Gini
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Citadel Cabasag
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Rui M. Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3Bʼs–PT Government Associate Laboratory, Braga, Portugal,Barretos Cancer Hospital, São Paulo, Brazil
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