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JCO Glob Oncol ; 7: 416-424, 2021 03.
Article in English | MEDLINE | ID: covidwho-1239918


PURPOSE: The coronavirus-induced pandemic has put great pressure on health systems worldwide. Nonemergency health services, such as cancer screening, have been scaled down or withheld as a result of travel restrictions and resources being redirected to manage the pandemic. The present article discusses the challenges to cancer screening implementation in the pandemic environment, suggesting ways to optimize services for breast, cervical, and colorectal cancer screening. METHODS: The manuscript was drafted by a team of public health specialists with expertise in implementation and monitoring of cancer screening. A scoping review of literature revealed the lack of comprehensive guidance on continuation of cancer screening in the midst of waxing and waning of infection. The recommendations in the present article were based on the advisories issued by different health agencies and professional bodies and the authors' understanding of the best practices to maintain quality-assured cancer screening. RESULTS: A well-coordinated approach is required to ensure that essential health services such as cancer management are maintained and elective services are not threatened, especially because of resource constraints. In the context of cancer screening, a few changes in invitation strategies, screening and management protocols and program governance need to be considered to fit into the new normal situation. Restoring public trust in providing efficient and safe services should be one of the key mandates for screening program reorganization. This may be a good opportunity to introduce innovations (eg, telehealth) and consider de-implementing non-evidence-based practices. It is necessary to consider increased spending on primary health care and incorporating screening services in basic health package. CONCLUSION: The article provides guidance on reorganization of screening policies, governance, implementation, and program monitoring.

COVID-19 , Mass Screening/organization & administration , Neoplasms/prevention & control , Breast Neoplasms/diagnosis , Breast Neoplasms/prevention & control , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/prevention & control , Delivery of Health Care , Early Detection of Cancer , Female , Health Policy , Humans , Mass Screening/methods , Neoplasms/diagnosis , Neoplasms/therapy , Pandemics , Practice Guidelines as Topic , Telemedicine , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
Prev Med ; 151: 106624, 2021 10.
Article in English | MEDLINE | ID: covidwho-1237916


Cancer screening programs from majority of the low- and middle-income countries (LMICs) report screening coverage as the only performance indicator, and that too measured through population-based sample surveys. Such information is unreliable and has very little value in assessing programmatic quality and impact. Regular monitoring of key process and outcome indicators based on data collected through a robust information system is essential to ensure quality of a screening programme. Fragmented health systems, limited resources and absence of a culture of systematic evaluation are the major hindrances for most of the LMICs to build electronic information systems to manage screening. The COVID-19 pandemic has created an impetus for the countries to customize the freely available District Health Information Software (DHIS2) to collect electronic data to track the outbreaks and manage containment measures. In the present article we present Bangladesh as an exemplar LMIC that has a (DHIS2) based integrated health information system gradually upgraded to collect individual data of the participants to the national cervical cancer screening program. Such efforts paid rich dividends as the screening program was switched from opportunistic to a population-based one. Moreover, the electronic system could report impact of the pandemic on cancer screening on a monthly basis. The aggregate number of women screened in the year 2020 was 14.1% less compared to 2019. The monthly rate of screening during peak of the outbreak was only 5.1% of the previous year. The rate rapidly recovered as the program intensified screening in the hard-to-reach regions less affected by the pandemic and expanded the outreach services. Other LMICs may emulate Bangladesh example. Customizing the information system developed for pandemic surveillance to collect cancer screening data will help them build back the screening programs better.

COVID-19 , Uterine Cervical Neoplasms , Bangladesh/epidemiology , Developing Countries , Early Detection of Cancer , Female , Humans , Pandemics , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis
Int J Cancer ; 149(1): 97-107, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1086364


We conducted a study to document the impact of COVID-19 pandemic on cancer screening continuum in selected low- and middle-income countries (LMICs). LMICs having an operational cancer control plan committed to screen eligible individuals were selected. Managers/supervisors of cancer screening programs were invited to participate in an online survey and subsequent in-depth interview. Managers/supervisors from 18 programs in 17 countries participated. Lockdown was imposed in all countries except Brazil. Screening was suspended for at least 30 days in 13 countries, while diagnostic-services for screen-positives were suspended in 9 countries. All countries except Cameroon, Bangladesh, India, Honduras and China managed to continue with cancer treatment throughout the outbreak. The participants rated service availability compared to pre-COVID days on a scale of 0 (no activities) to 100 (same as before). A rating of ≤50 was given for screening services by 61.1%, diagnostic services by 44.4% and treatment services by 22.2% participants. At least 70% participants strongly agreed that increased noncompliance of screen-positive individuals and staff being overloaded or overwhelmed with backlogs would deeply impact screening programs in the next 6 months at least. Although many of the LMICs were deficient in following the "best practices" to minimize service disruptions, at least some of them made significant efforts to improve screening participation, treatment compliance and program organization. A well-coordinated effort is needed to reinitiate screening services in the LMICs, starting with a situational analysis. Innovative strategies adopted by the programs to keep services on-track should be mutually shared.

COVID-19/prevention & control , Communicable Disease Control/methods , Early Detection of Cancer/statistics & numerical data , Neoplasms/diagnosis , SARS-CoV-2/isolation & purification , Surveys and Questionnaires/statistics & numerical data , Bangladesh , Brazil , COVID-19/epidemiology , COVID-19/virology , Cameroon , China , Cross-Sectional Studies , Developing Countries , Early Detection of Cancer/methods , Honduras , Humans , India , Neoplasms/therapy , Pandemics , SARS-CoV-2/physiology