Assessing the long-term impacts of the COVID-19 pandemic on disparities in cancer screening and follow-up

PROJECT SUMMARY/ABSTRACT: The COVID-19 pandemic has led to dramatic reductions in cancer screening and follow-up services. During the early months of the pandemic, national organizations recommended postponing all routine cancer screening, resulting in dramatic reductions in adult primary care and specialty care visits; current rates remain far below pre-pandemic levels. Modeling suggests that these reductions will result in over 57,000 missed cancer diagnoses and 10,000 excess deaths over the next decade. However, these models are largely informed by data sources made up predominantly of insured patients and lacking race/ethnicity information. Thus, more information is needed to understand the strategies and resources need to support the recovery of health systems and communities that have been most impacted by COVID-19. The effects of the pandemic on cancer screening uptake may be particularly profound for patients served by resource-limited federally qualified health centers (FQHCs), which deliver services a large share of patients with incomes below the federal poverty level and who are Latinx. Latinx populations already have some of the lowest rates of cancer screening and follow-up care in the United States and are likely to experience the largest reductions in care and slower return to normal following COVID-19. This is, in part, because their communities have been hit particularly hard by COVID-19 (e.g. high rates of COVID-19 infections and hospitalizations and job loss) and they may fear returning for preventive care even when medical authorities have deemed it safe. Our proposed mixed-methods study will estimate the impact of the COVID-19 pandemic on rates of cancer screening and follow-up in patients served by a large, diverse FQHC (Aim 1), and estimate impacts on cancer outcomes (e.g. changes in life years gained, cancers prevented, and late-stage cancer incidence) in the FQHC population building on models developed by the CRC-SPN Cancer Intervention and Surveillance Modeling Network (Aim 2). Finally, we will gather qualitative data from clinic staff and patients to identify opportunities to improve post-pandemic cancer preventive care delivery for adults served by FQHCs (Aim 3). There is a critical need to understand the long-term impacts of COVID-19-care reductions on vulnerable populations and identify opportunities to meet the ongoing cancer prevention needs of patients served by FQHCs. We will collaborate with national stakeholders to develop FQHC-specific guidance to inform future interventions to support recovery from COVID-like care disruptions Thus, our findings will support access to care and reduction of health disparities for communities most impacted by COVID-19.