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Following the dramatic decrease in cancer screenings, visits, therapy, and surgeries observed during the COVID-19 pandemic, U.S. healthcare organizations must now take deliberate steps to mitigate the impacts of delayed diagnoses and care. Comparing March to July 2020 to March to July 2019, screenings were down as much as 85%, visits were down by over 70%, and there was an over 50% decrease in mastectomy and colectomy surgeries. Postponements in elective procedures and patient fears of contracting the coronavirus during in-person visits were the core causes of this major drop in care.
While healthcare providers worked to manage the gap in a variety of ways, including telemedicine visits and treating oncology patients medically until surgery was available, the entire healthcare system was under strain as it cared for influxes of patients with COVID-19. The impact of these delays could sadly be felt for years to come.
A treatment delay of as little as 4 weeks for chemotherapy, surgery, or radiation therapy can lead to an increased risk of death. The National Cancer Institute estimates there could be close to 10,000 excess deaths from breast and colorectal cancer over the next decade as a result of screening and treatment delays incurred during the pandemic, with patients presenting with later stages of disease.
As the vaccination rollout continues and the incidence of COVID-19 decreases, healthcare systems will return to a balance of support across all disease types. Unusual delays in cancer treatment will be eliminated, and providers will regain full access to the resources they need to support patients throughout their treatment journey.
Approaches used during the pandemic to mitigate strains on individual providers and the healthcare system as a whole may now be adapted to help close cancer screening gaps and manage potential surges of patients with new cancer diagnoses. The following list highlights four such approaches that could effectively encourage patients to reenter the system, participate in screenings, and visit their providers when they are experiencing symptoms rather than postponing appointments out of lingering fear or anxiety.
The pandemic held many lessons regarding effective—and ineffective—public health messaging. Focusing on what worked, we can take similar approaches to closing the backlog of cancer screenings and encouraging patients to return to their providers. Healthcare providers, systems, and local governments can create educational outreach programs to reassure the public that visiting their doctor is safe. Many COVID-19 safety protocols for cleaning and social distancing will remain in place for now—and perhaps even become standard practice—which will be comforting to the public as they return to in-person medical care.
Much like what’s been done to manage the surge in COVID-19 testing, vaccinations, and patient care, healthcare organizations should consider developing a “surge support” workforce to focus on cancer screenings. Such a support staff may be necessary to help manage a likely surge of patients with new cancer diagnoses, especially if more patients than usual present with more advanced stages of the disease.
During the pandemic, healthcare systems quickly adapted innovative approaches like telehealth to provide safe and effective remote care to patients and “meet them where they are.” These same and similar approaches, like mobile mammogram programs and increased at-home screenings for colon and cervical cancers, could be used to address the cancer screening backlog. A small community health center in Philadelphia succeeded in boosting colorectal cancer screenings by 1,000% using take-at-home kits, and 62% of people surveyed by a cervical cancer charity in the UK said they would prefer at-home screening to seeing a clinician if the test was easy and reliable. To ensure that insurance coverage is not an impediment to participation in screenings, insurers should be encouraged to reduce or eliminate any barriers to patients receiving screening or follow-up diagnostic testing (e.g., out-of-network billing, decreased coverage for diagnostic work-ups), especially for higher volume cancer types like breast and colon. Research for at-home screening should be a priority.
For patients diagnosed with cancer, healthcare systems should continue to expedite initial workups, move quickly to start treatment, and prioritize second opinions to avoid delays. To track what works, healthcare systems need a means to measure their successes in closing the cancer screening backlog and managing patients diagnosed with the disease. There are some current quality metrics related to screening and treatment timing that may capture success, but new ones may need to be developed as well, such as patient-reported outcomes on the quality and timeliness of the in-person care they’re now receiving.
Every facet of U.S. healthcare was disrupted to some degree by the pandemic—cancer care is no exception. Now is the time to catch up and come back stronger by following the relevant research, and taking swift, purposeful action to the benefit of patients, providers, and the systems they rely on.
About the Author
Barbara Doyle RN, MSN, PMP is a lead associate at Booz Allen. She has more than 10 years of experience in both oncology nursing and clinical quality improvement, which she draws on to support learning system activities for CMS advanced alternative payment models.