ABSTRACT
Background: Disruptions to cancer care during the COVID-19 pandemic due to disease mitigation efforts, supply-chain issues, and fear of COVID-19 have all been reported, but study of their extent has been limited. The purpose of this study is to evaluate the extent and associations with patient reported disruptions to cancer treatment and other care during the COVID-19 pandemic using nationally representative data. Methods: This cross-sectional study uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey of US adults. Adults who reported requiring current cancer treatment or other care related to their cancer in the second half of 2020 were included. Rates of patients with self-reported changes, delays, or cancellations to cancer treatment or other cancer-related care due to the COVID-19 pandemic were calculated and their associations with demographic and other variables were analyzed. All data were adjusted using sample weights and specific variables to account for stratification and other survey characteristics using the Stata svy command. Chi-square testing was used to compare proportions across variable groups. Univariable logistic regression analysis was utilized to assess variable associations with change, delay, or cancellations to cancer care during the COVID-19 pandemic. Multivariable logistic regression analysis was used to create a model adjusted for select demographic variables. Results: A sample-weighted 2,867,326 adults (n=574) reported requiring cancer treatment and/or other cancer care since the start of the COVID-19 pandemic. Of these, 189 (32.1%) reported any change, delay, or cancellation due to the pandemic. On univariable analysis, patients who were younger, female, had comorbidities, and uninsured were significantly more likely to report care disruptions. On adjusted analysis, younger age and female sex remained significant predictors. In a sample-weighted subset of 1,600,587 patients (n=331), 291 (87.9%) reported virtual appointment use. There was no association with disruptions across breast, prostate, lung, and colorectal cancer groups. Conclusions: Approximately 1/3 of patients experienced disruptions to cancer care during the COVID-19 pandemic. Patients with younger age or female sex were more likely to have disruptions in care, which may reflect risk stratification strategies in the early stages of the pandemic. The longitudinal impact of these disruptions on outcomes merits further study.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The Covid-19 pandemic has disrupted every facet of medical care, without exception in urologic cancer care. Access to care and surgery rates significantly decreased during the initial period of the pandemic, but the overall impact on care and survival has not yet been fully appreciated. This study aims to characterize and analyze patient reported delays in treatment or ancillary care due to the pandemic for the two most common urologic cancers, prostate cancer (PC) and bladder cancer (BC) at the national level. METHODS: This retrospective, cross-sectional study used the National Health Interview Survey 2020, which consists of a nationally representative sample of 31,568 adults 18 or older. Data were then weighted to account for complex survey design and provide national estimates. Patients with a known history of PC or BC were included. Proportion of patients reporting changes, delays, or cancellations to cancer treatment or other ancillary care during the pandemic were analyzed and compared across cancer groups. RESULTS: A sample-weighted estimate of 1,720,245 patients with history of PC (n=1,439,867, 83.7%) or BC (n=280,379, 16.3%) of known treatment or other care status during Covid-19 were included. 282,929 (16.5%) reported receiving or supposed to be receiving treatment since the start of the pandemic, while 298,116 (17.3%) reported needing other care including lab visits, imaging, monitoring visits, rehabilitation, physical therapy, care for side-effects, or visits with medical specialists. Of those receiving or supposed to be receiving treatment, 76,984 (27.2%;95% CI 15.7-43.0%) reported their cancer treatment was changed, delayed, or cancelled due to the pandemic, with no significant difference between those with history of PC vs. BC (27.2% vs. 27.5%;P=.99). Of those needing other care, 73,189 (24.5%;95% CI 13.8-39.7%) reported change, delay, or cancellation due to the pandemic, again with no significant difference between patients with history of PC vs. BC (24.4% vs. 26.0%;P=0.93). CONCLUSIONS: Approximately 1/4 of PC and BC patients requiring treatment or other ancillary care during the pandemic reported change, delay, or cancellation. Delays in BC treatment have previously been shown to increase mortality, thus necessitating further study of the long-term implications of delays due to the Covid-19 pandemic on outcomes.