Cancer Evaluations During the COVID-19 Pandemic: An Observational Study Using National Veterans Affairs Data
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Introduction: Fewer cancer diagnoses have been made during the COVID-19 pandemic. Pandemic-related delays in cancer diagnosis could occur from limited access to care or patient evaluation delays (e.g., delayed testing after abnormal results). Follow-up of abnormal test results warranting evaluation for cancer was examined before and during the pandemic.
Methods: Electronic trigger algorithms (“e-triggers”) were applied to Department of Veterans Affairs’ electronic health record (EHR) data to assess follow-up of abnormal test results before (March 10, 2019‒March 7, 2020) and during (March 8, 2020‒March 6, 2021) the pandemic.
Results: E-triggers were applied to 8,021,406 veterans’ EHRs to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder (urinalysis with high-grade hematuria), breast (abnormal mammograms), colorectal (positive fecal occult blood tests/fecal immunochemical tests [FOBT/FIT] or results consistent with iron deficiency anemia [IDA]), liver (elevated alpha-fetoprotein), and lung (chest imaging suggestive of malignancy). Between pre-pandemic and pandemic periods, test quantities decreased by 12.6%‒27.8%; and proportions of abnormal results lacking follow-up decreased for urinalyses (‒0.8%), increased for FOBT/FIT (+2.3%) and chest imaging (+1.8%), and remained constant for others. Follow-up times decreased for most tests; however, control charts suggested increased delays at 2 stages: ‘Early’ (pandemic beginning) for urinalyses, mammograms, FOBT/FIT, IDA, and chest imaging; and ‘Late’ (30‒45 weeks into pandemic) for mammograms, FOBT/FIT, and IDA.
Conclusions: While early pandemic delays in follow-up may have led to reduced cancer rates, the significant decrease in tests performed is likely a large driver of these reductions. Future emergency preparedness efforts should bolster essential follow-up and testing procedures to facilitate timely cancer diagnosis.
American Journal of Preventive Medicine , article en libre accès, 2021