CHANGE IN COLORECTAL CANCER SCREENING PATTERNS IN A SAFETY-NET HOSPITAL AND A PRIVATE HEALTH SYSTEM DURING THE COVID-19 PANDEMIC

ABSTRACT

Background The COVID-19 pandemic led to significant alterations in the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening, though the impact on different types of healthcare systems remains unclear. We aimed to quantify and compare the effect of the first wave of the pandemic on CRC screening uptake at a safety-net hospital and a private health system based in New York City (NYC). Methods In this retrospective study, we identified individuals aged 50 to 75 years presenting for outpatient care at a safety-net public hospital (Bellevue Hospital) and private health system (NYU Langone Health) in March through September of 2019 and 2020 (first wave of the pandemic in NYC). We excluded those who were up-to-date with CRC screening before each study period or had a prior diagnosis of CRC, hereditary cancer syndrome, inflammatory bowel disease, or colectomy. The primary outcome was the proportion of screening-eligible patients seen in the outpatient setting who underwent CRC screening. Results The safety-net hospital had a total of 9,569 outpatient visits in 2019 and 7,280 in 2020. Overall, 552 (5.8%) and 289 (4.0%) screening tests were completed in 2019 and 2020, respectively (p < 0.01). Of these, there were 382 (69.2%) fecal immunochemical tests (FIT) in 2019 and 256 (88.6%) in 2020 (p < 0.01). For individuals who had positive FIT results, 17.2% in 2019 and 25.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.62). A total of 5 and 3 cases of CRC were diagnosed in 2019 and 2020, respectively. In the private health system, there were 99,889 visits in 2019 and 33,849 in 2020. Overall, 658 (0.66%) and 250 (0.74%) completed screening tests in 2019 and 2020, respectively (p = 0.13). Of the screening tests, 518 (78.7%) were FIT in 2019 and 206 (82.4%) were in 2020 (p = 0.22). Of the positive FIT results, 29.4% in 2019 and 27.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.80). A total of 97 and 43 CRC cases were diagnosed in 2019 and 2020, respectively. Conclusion In our study of a safety-net hospital and a private health system in NYC, outpatient volume and absolute numbers of screening tests and CRC diagnoses decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening rate and increase in proportional FIT use in the public hospital but not the private health system. Although colonoscopy follow-up rate after positive FIT results were low for both institutions, which may reflect incomplete capture of colonoscopy examinations, there were no differences before and during the pandemic. (Table Presented) (Table Presented)