ABSTRACT
Background: COVID-19 disrupted the healthcare system and services across the cancer continuum. Early on, breast and cervical (B & C) screenings were effectively halted, and many diagnostic and treatment procedures delayed. Emerging evidence suggests that uninsured populations and patients of color were disproportionately affected, but less is known about ruralurban differences. The Illinois Breast and Cervical Cancer Screening Program (IBCCP), administered by agencies across 102 counties, provides screening and diagnostic services for lowincome, uninsured, and underinsured persons. This study assesses the impact of COVID-19 on agencies' administrative functions and clients' ability to receive services, and to examine rural-urban differences. Method(s): IBCCP coordinators were invited to complete an online survey that asked about COVID-19's effect on administrative functions and services at two different time periods, the height of the pandemic and in the past month (11/2021-12/2021). Chi-square and Fisher's exact tests were used to examine differences between rural and urban agencies (classified by using the 2013 NCHS Urban-Rural Classification Scheme). Result(s): In total, 32 agencies (50% urban, 50% rural), responded. Concerning administrative functions, in the past month compared to at the height of the pandemic, fewer agencies overall reported that COVID-19 had a moderate to great impact (compared to occasional or no impact) on staffing (47% vs. 74%) and client enrollment (34% vs. 90%). Although not significant, more rural than urban agencies reported effects on staffing (56% vs. 38%) and enrollment (50% vs. 19%) in the past month. Concerning clients' ability to receive services, in the past month compared to the height of the pandemic, fewer agencies overall reported COVID-19 effects on screening (31% vs. 75%), diagnostic (19% vs. 61%), and treatment (3% vs. 38%) services. Some rural-urban differences were noted;at the height of the pandemic, urban agencies were more likely to report effects on diagnostic (88% vs. 33%, p=.002) and treatment (56% vs. 19%, p=.028) services when compared to rural. Although not significant, in the past month, more urban (vs. rural) agencies reported COVID-19 related effects on screening (44% vs. 19%), diagnostic (31% vs. 6%), and treatment (7% vs. 0%) services. Conclusion(s): Overall, agencies implementing this safety net program are generally rebounding from the pandemic's effect on administrative functions and clients' ability to receive services. However, rural and urban agencies may be differentially affected by the pandemic. For example, in the past month, a greater proportion of rural agencies reported effects on administrative functions Interestingly, more urban agencies reported lingering effects on clients' ability to receive screening and diagnostic services. These trends suggest that rural and urban agencies may be differentially affected by the pandemic and geographically tailored responses may best support recovery.
ABSTRACT
Background: The COVID-19 pandemic exacerbated health inequities among systematically marginalized populations. At the onset of the pandemic, routine cancer screenings were effectively halted;from March to May 2021, there was a deficit of 9.3 million screens. Early evidence suggests that non-White patients, compared to White, have experienced even greater declines in breast and cervical cancer screenings. Consequences of missed or late screenings include later stage diagnosis and poor outcomes. Community navigation programs have been used to promote engagement in cancer screenings in under-resourced communities, but these too were interrupted as restrictions were put in place to mitigate the spread of COVID-19. Objective(s): To use a mixed methods approach to describe the challenges, strengths, and lessons learned of implementing a community navigation program for breast and cervical cancer screening during the COVID-19 pandemic. Method(s): In 2019, The University of Illinois Cancer Screening, Access, Awareness, and Navigation (UI CAAN) intervention was established to address breast and cervical cancer disparities on Chicago's West side, an area with large Black and Latinx populations. The intervention included community navigators who worked in partnership with community-based safety net hospitals and organizations. Participants were recruited at community events and through clinical referrals and were eligible if they were overdue for a guideline concordant breast or cervical cancer screening. Quantitative navigation and screening data were collected by the navigators in a REDCap database. Qualitative data, four focus groups with participants and partners, were also collected to broaden our understanding of impact of COVID-19 on the community navigation intervention. For these analyses, we describe participants' navigation and screening outcomes and use content analysis methods for the focus groups. We then triangulate the findings to understand the challenges, strengths, and lessons learned of the UI CAAN. Result(s): From 2019-2022, a total of 366 individuals were navigated for breast and cervical cancer screenings. Of these, 68% (n = 248) received a breast and/or cervical cancer screening. Among those who were screened, 75% were Latinx and 23% were Black, 92% were uninsured, and 86% did not have a primary care provider. Concerning services received, 30% had a mammogram and a pap smear, 37% a pap smear only, and 33% a mammogram only. At the height of the pandemic, navigators coordinated with community and clinical partners to deliver 500 meals, held 9 PPE distribution events, distributed 3000 masks, and conducted 2 webinars about COVID-19. Conclusion(s): Despite the challenges of the COVID-19 pandemic, the UI CAAN community navigation program was able to shift its efforts at the height of the pandemic to assist its community and clinical partners. The continued collaboration allowed for a successful resumption of navigation and screening efforts once healthcare systems were able to re-engage patients in cancer screenings.
ABSTRACT
Background: Comprehensive cancer control (CCC) plans are region-specific blueprints that identify cancer priorities and health equity informed strategies to address cancer burden and are supported by the National Comprehensive Cancer Control Program through the Centers for Disease Control and Prevention (CDC). Although CCC plans are created by stakeholder coalitions, few have focused on community engaged approaches, which may diminish their applicability for community members. Thus, in preparation for its forthcoming 2022-2027 CCC plan, the Illinois Comprehensive Cancer Control Program collaborated with the University of Illinois Cancer Center's Community Engagement and Health Equity office to implement a community engagement strategy to address cancer burden. Objective: To describe the development and implementation of a community engagement strategy for the 2022-2027 Illinois CCC plan. Method: The goal of the community engagement strategy was to identify barriers, facilitating factors and recommendations related to cancer burden and equity in Illinois by engaging diverse community stakeholders. A statewide town hall and focus groups (FGs) were implemented in early 2021. Thedevelopment and analysis of the community engagement strategy were guided by the Model for Analysis of Population Health and Health Disparities, CDC's CHANGE Action Guide, and the Community ToolBox. Semistructured guides included questions about fundamental causes of health, social and physical contexts, individual demographics and risk factors, and biologic responses and pathways. The town hall was open to Illinoisians over 18 years of age. FG participants were selected using purposive sampling to maximize group heterogeneity. Eight FGs were held, one each for: rural residents, survivors, young survivors, caregivers, and Spanish speakers, and three that were a mix of community members. Town hall notes and FGs were analyzed using content analysis. Results were synthesized and a final report was included in the forthcoming plan. Results: Town hall and FG (n=8) participants (n=115) included cancer survivors (36%), caregivers (27%), Latinos (17%), African Americans (23%), and rural residents (14%). Throughout the development of the plan, data were continuously reviewed with the coalition developing the CCC Plan. The final report described multi-level factors that contribute to cancer disparities among Illinoisians, proposed recommendations to improve health across the cancer continuum across multiple levels, funding priorities, and the impact of COVID-19 on cancer care. Participant quotes supported strategies throughout the plan. Conclusion: A robust community engagement strategy for the forthcoming 2022-2027 Illinois CCC Plan was implemented through a successful academic-state public health department partnership. This strategy ensures that the plan reflects the expertise and voices of Illinoisians impacted by cancer. This engagement strategy, framed around health determinants that impact cancer risk and outcomes, may be replicated by other coalitions creating CCC plans.