ABSTRACT
BACKGROUND: Timely follow-up of abnormal cancer screening test results (“abnormal screens”) is critical but often not achieved. As part of an NCI funded intervention trial (mFOCUS: multilevel Follow-up of Cancer Screening, ClinicalTrials.gov NCT03979495), we report on abnormal screens that were identified and tracked to identify eligible patients overdue for study inclusion. While not anticipated when this study was conceived, the COVID-19 pandemic resulted in a larger than anticipated backlog of patients in need of follow-up of abnormal screens. METHODS: Patients in two primary care practice networks affiliated with Mass General Brigham who had an abnormal screen for breast, cervical or lung cancer were identified using computerized algorithms and then tracked for completion of appropriate follow-up based upon the cancer type and the severity of the abnormal result. Since the intervention was designed as a “fail safe” system, additional time (2-6 months depending on the severity of the abnormal screen) was added after the recommended follow-up interval. We report the number of abnormal screens by cancer type and severity of the abnormality and the number of patients who completed follow-up based upon guideline and expert recommendations. RESULTS: Patient tracking and enrollment started with abnormal screens for breast and lung on 8/24/2020 and cervical cancer on 10/16/2020. Enrollment ended for all abnormal screens on December 15, 2021. Over the study period, 4003 abnormal breast, 5214 abnormal cervical, and 478 abnormal lung screens were identified. High risk abnormalities were most common for cervical (51.7%, recommended colposcopy or endometrial biopsy), lung (22.6%, LRADS 4B, 4X or 5), and lowest for breast (0.4%, BIRADS 5). Rates of completing recommended follow-up of abnormal screens by cancer type and severity of the result are shown in the table. CONCLUSIONS: Maximizing the benefits of cancer screening requires the timely follow-up of abnormal screening results. Though likely exacerbated by the COVID-19 pandemic, we identified that timely completion of abnormal screens is often not achieved. Rates of completion varied by cancer type and the severity of the abnormal result but highlight the need for systems based, multi-level interventions to identify, report and track abnormal results.
ABSTRACT
The paper details a course offering that centers on student transformational experience and self-efficacy growth in an international environment by merging business, entrepreneurship and cultural experiences. Self-efficacy is achieved through both a mastery experience, mastering a task and controlling the environment, and vicarious experience through observation of people and activities. An inexpensive but very effective combination of multi-cultural virtual and in situ team work with a strong cultural component provides the transformational experience. Originally involving only two universities, one in China and one in the United Sates, the course has expanded over the years of its existence to four participating universities, each representing a different continent. The virtual pre-travel component, which was always an important part of the course design, became especially prominent during the COVID-19 pandemic. The advantages and challenges associated with the course design and implementation are discussed. © 2021
ABSTRACT
Background: The Covid-19 pandemic has affected all aspects of life. Integra Connect sought to assess its impact on new visits for cancer care by querying its Electronic Medical Record and Claims database as a surrogate for understanding Covid's impact on cancer care in the larger United States population. Methods: Using Real World Data (RWD) from over 1200 oncology providers in 14 large practice settings, comprising 250 plus care sites in the ICD, we measured new patient (Pt) and established Pt visits from 2018 through 2020. Centers for Medicare & Medicaid Services (CMS) codes for new and established Pt's were applied to define cohorts. Disease states were defined using CMS Oncology Care Model (OCM) mapping to diagnosis codes. Because the ICD is heavily based in the Eastern US, we conducted a geographic analysis by segmenting providers by Northeast (NE) with 506 providers from NY, NJ, PA, and VA and Southeast (SE) with 578 providers from FL, GA, SC, and AL. We looked at visits across all tumor types and identified breast cancer (BC) and colorectal cancer (CC) as likely to be most affected by decreased screening, and multiple myeloma (MM) and advanced prostate cancer (APC) as likely to be vulnerable to delay in initiation of first treatment since treatment often trails diagnosis. Results: We found a decline in new patient volume (NPV) in '20 of -1% compared to '19;this compared to an anticipated increase of +7% based on growth in NPV in the ICD from '18 to '19. In the NE we saw NPV decrease in '20 by -7% vs. '19 but increase by +6% in the SE compared to '19. In comparing NPV '20 to '19 and '19 to '18, we saw a smaller increase for BC of +4% vs. +6% and for CC of +5% vs. +7%, respectively. Whereas in MM it was -7% vs. +3% and APC -6% vs. +8%. (See Table). Conclusions: Covid-19 has negatively impacted cancer care access. This RWD shows the number of both newly diagnosed Pts and those with initial oncologic intervention in established Pts, where symptoms traditionally have determined initiation of treatment, has declined year-overyear. The American Cancer Society projected new Pt cases to increase +2% in '20 to 1.806 million (ACS, Cancer Facts and Figures 2020), whereas in the ICD, that figure was projected +7% but resulted in -1%. This suggests a major expected reduction of new Pt cases in the US at large. The drop in cases during Covid-19 in our data was greater in the NE compared to the SE. In addition, the drop in the NE in our data was earlier and more prolonged than SE. While recovery occurred in both regions, after an initial overshoot following lockdowns, volumes plateaued at levels lower than pre-pandemic.