Assessing the impact of the COVID-19 pandemic on a statewide breast and cervical cancer safety net screening and diagnostic program: Are there differences by rural - urban geography?

ABSTRACT

Background: COVID-19 disrupted the healthcare system and services across the cancer continuum. Early on, breast and cervical (B & C) screenings were effectively halted, and many diagnostic and treatment procedures delayed. Emerging evidence suggests that uninsured populations and patients of color were disproportionately affected, but less is known about ruralurban differences. The Illinois Breast and Cervical Cancer Screening Program (IBCCP), administered by agencies across 102 counties, provides screening and diagnostic services for lowincome, uninsured, and underinsured persons. This study assesses the impact of COVID-19 on agencies' administrative functions and clients' ability to receive services, and to examine rural-urban differences. Method(s) IBCCP coordinators were invited to complete an online survey that asked about COVID-19's effect on administrative functions and services at two different time periods, the height of the pandemic and in the past month (11/2021-12/2021). Chi-square and Fisher's exact tests were used to examine differences between rural and urban agencies (classified by using the 2013 NCHS Urban-Rural Classification Scheme). Result(s) In total, 32 agencies (50% urban, 50% rural), responded. Concerning administrative functions, in the past month compared to at the height of the pandemic, fewer agencies overall reported that COVID-19 had a moderate to great impact (compared to occasional or no impact) on staffing (47% vs. 74%) and client enrollment (34% vs. 90%). Although not significant, more rural than urban agencies reported effects on staffing (56% vs. 38%) and enrollment (50% vs. 19%) in the past month. Concerning clients' ability to receive services, in the past month compared to the height of the pandemic, fewer agencies overall reported COVID-19 effects on screening (31% vs. 75%), diagnostic (19% vs. 61%), and treatment (3% vs. 38%) services. Some rural-urban differences were noted;at the height of the pandemic, urban agencies were more likely to report effects on diagnostic (88% vs. 33%, p=.002) and treatment (56% vs. 19%, p=.028) services when compared to rural. Although not significant, in the past month, more urban (vs. rural) agencies reported COVID-19 related effects on screening (44% vs. 19%), diagnostic (31% vs. 6%), and treatment (7% vs. 0%) services. Conclusion(s) Overall, agencies implementing this safety net program are generally rebounding from the pandemic's effect on administrative functions and clients' ability to receive services. However, rural and urban agencies may be differentially affected by the pandemic. For example, in the past month, a greater proportion of rural agencies reported effects on administrative functions Interestingly, more urban agencies reported lingering effects on clients' ability to receive screening and diagnostic services. These trends suggest that rural and urban agencies may be differentially affected by the pandemic and geographically tailored responses may best support recovery.