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Introduction: Lung cancer is the leading cause of cancer-related death in the US with an estimated 236,740 new cases and 130,180 deaths expected in 2022. While early detection with low-dose computed tomography reduces lung cancer mortality by at least 20%, there has been a low uptake of lung cancer screening (LCS) use in the US. The COVID-19 pandemic caused significant disruption in cancer screening. Yet, little is known about how COVID-19 impacted already low use of LCS. This study aims to estimate LCS use before (2019) and during (2020 and 2021) the COVID-19 pandemic among LCS-eligible population in the US. Method(s): We used population-based, nationally representative, cross-section data from the 2019 (n=4,484), 2020 (n=1,239) and 2021 (n=1,673) Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. The outcome was self-reported LCS use among eligible adults in the past 12 months. For 2019 and 2020, the eligibility was defined based on US Preventive Services Task Force (USPSTF) initial criteria-adults aged 55 to 80 years old, who were current and former smokers (had quit within the past 15 years) with at least 30 pack years of smoking history. For 2021, we used the USPSTF updated criteria- adults aged 50 to 80 years, current and former smokers (who had quit within the past 15 years) with at least 20 pack years of smoking history. We applied sampling weights to account for the complex survey design to generate population estimates and conducted weighted descriptive statistics and logistic regression models. Result(s): Overall, there were an estimated 1,559,137 LCS-eligible respondents from 16 US states in 2019 (AZ, ID, KY, ME, MN, MS, MT, NC, ND, PA, RI, SC, UT, VT, WV, WI), 200,301 LCS-eligible respondents from five states in 2020 (DE, ME, NJ, ND, SD), and 668,359 LCS-eligible respondents from four states in 2021 (ME, MI, NJ, RI). Among 2,427,797 LCS-eligible adults, 254,890;38,875;and 122,240 individuals reported receiving LCS in 2019, 2020 and 2021, respectively. Overall, 16.4% (95% CI 14.4-18.5), 19.4% (95% CI 15.3-24.3), and 18.3% (95% CI 15.6-21.3) received LCS during 2019, 2020, and 2021, respectively. In all years, the proportion of LCS use was higher among adults aged 65-74, insured, those with fair and poor health, lung disease and history of cancer (other than lung cancer). In 2020, a higher proportion of adults living in urban areas reported receiving LCS compared to those living in rural areas (20.36% vs. 12.7%, p=0.01). Compared to non-Hispanic White adults, the odds of receiving LCS was lower among Hispanic adults and higher among Non-Hispanic American Indian/Alaskan Native adults in 2020 and 2021, respectively. Conclusion(s): LCS uptake remains low in the US. An estimated 2,011,792 adults at high-risk for developing lung cancer did not receive LCS during 2019, 2020 and 2021. Efforts should be focused to increase LCS awareness and uptake across the US to reduce lung cancer burden.
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Background: Limited research is available about cancer survivors' level of stress, social connectedness and loneliness during the COVID-19 that can put them at increased risk for poor physical and mental health. We estimated relative decreased rate of social connectedness and increased rates of loneliness/ sadness and stress/anxiety among cancer survivors during the 2020-2021 winter surge of COVID- 19 and investigated whether decreased social connectedness is associated with increased feelings of loneliness/sadness and stress/anxiety. Methods: This cross-sectional study used data from Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement, nationally representative phone survey of Medicare beneficiaries living in community, conducted in March-April 2021. We included 1,836 respondents who self-reported cancer history (other than skin cancer). Outcomes were self-reported feelings of loneliness/sadness and stress/anxiety over the past 4 months. The independent variable was social connectedness defined as feeling less socially connected to family/friends over the past 4 months. We used weighted descriptive statistics and multivariable logistic regression adjusting for self-reported socio-demographics (age, sex, race, income), region, metropolitan residency, Medicaid eligibility, living alone, depression, having access to internet and health care. We applied sample weights to account for complex survey design with results generalizable to 9.5 million cancer survivors. Results: Out of 9505626 cancer survivors, 6.8% self-reported as Black, 7.1% Hispanic, 80.4% White, 59% women, 42.7% reported decreased social connectedness, 20.3% increased feeling of loneliness/ sadness, and 40.0% increased feeling of stress/anxiety in the past 4 months. Women had higher rates of reporting increased feelings of loneliness/sadness (12.0% vs. 26.1%, P = <.001), stress/anxiety (30.0% vs. 46.6%, P = <.001), and decreased social connectedness (38.7% vs. 45.5% P =.028) than men in the past 4 months. Among self-reported racial and ethnic groups, Hispanics had the highest rates of reporting increased feelings of loneliness/sadness (31.2% vs. 20.5% of Whites vs. 10.2% of Blacks, P =.008) and stress/anxiety (54.0% vs. 39.4% of Whites vs. 31.2% of Blacks, P =.034). No statistically significant difference was found in social connectedness by self-reported race and ethnicity. Survivors who reported decreased social connectedness had higher odds of feeling more lonely/ sad (adjusted OR = 3.67, 95%CI 2.85-4.72, P = <.001) and more stressed/anxious (adjusted OR = 2.63, 95%CI 2.1- 3.26, p = <.001) over the past 4 months. Conclusions: Increased feelings of loneliness/ sadness and anxiety/stress in the past 4 months were prevalent among cancer survivors. Also, almost half of them reported decreased social connectedness at the end of the second year of COVID- 19.
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COVID-19 has been associated with various cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is severe in patients with pre-existing cardiovascular disease, and in these cases the systemic inflammatory response due to a cytokine storm can lead to acute myocardial infarction. Hypercoagulation in COVID-19 can also predispose patients to fatal vascular events. Furthermore, these patients also have high hematocrit and platelet values, which, in their turn, contribute to the high risk of vascular events. We hypothesize that the use of anticoagulants and antiplatelets is decisive for prevention of acute coronary syndromes, especially in patients with pre-existing cardiovascular diseases. Prospective cohort study was conducted in patients with confirmed diagnosis of COVID-19 admitted to National Center for Infectious Diseases Ministry of Health of the Republic of Armenia. Clinical, laboratory data, total and cardiovascular mortality, the incidence of a myocardial infarction and treatment regimens were compared in two groups according to the time of the hospitalization: 40-day period in April-May (I Group) and October-November (II Group). Totally195 patients were enrolled in the study, which were divided into two groups. In I Group there were 93 patients with 36,5% of pre-existing cardiovascular diseases, in II Group 102 patients with 38,2% of pre-existing cardiovascular diseases. There was also drastic difference in laboratory test results between two groups. I Group was managed with minimal infusion therapy and only 10,7% received anticoagulation. In contrast, II Group was receiving preventive doses of anticoagulants and antiplatelet, and proper infusion therapy was administered. In I Group 7 cases of myocardial infarction were recorded, while patients in II Group, only 3 cases (1 of them with previous 1 of them with previous myocardial infarction). Statistical analysis revealed no significant difference in overall mortality (4.3% vs 6.86%, p = 0.441) and myocardial infarction incidence (7.5% vs 2.9%, p = 0.149) between two groups. In contrast there was significant difference in the incidence of severe and critically ill cases between two groups (69.9% and 7.5% vs 75.5% and 20.6%, p < .001).