Cancer screening fell far behind during the crisis phase of the COVID-19 pandemic – likely worsening inequalities in prevention and care that already exist for underserved populations. But new research shows how it’s possible for health systems to endure major disruptions and drive rapid recovery of preventive services.
Researchers at Oregon Health & Science University led by Nathalie Huguet, Ph.D., in collaboration with OCHIN, studied cancer screening efforts during the pandemic at more than 200 community health centers located in 13 states. Community health centers serve people who cannot afford to pay for health care.
The researchers used electronic health records to track monthly rates of up-to-date screening for colorectal cancer and cervical cancer. They followed up with semistructured interviews from 13 community health centers. The data analysis focused on three pandemic-related periods: March–May 2020, June–October 2020, and November 2020–September 2021.
At the outset of the pandemic, screening for colorectal cancer fell by 75% for colonoscopy and by 78% for fecal immunochemical test (FIT)/fecal occult blood test (FOBT). Pap tests for cervical cancer fell by 87%. While screening rates trended toward recovery after 6 months, overall rates did not recover to pre-pandemic levels.
But the researchers found a wide range of experiences; some health centers found ways to maintain services, or more quickly reach partial or full recovery of cancer screening services.
Some used innovative strategies, such as coupling telemedicine visits with the distribution of FIT/FOBT kits by mail to improve colorectal screening completion rates. One health center, which had a high rate of cervical cancer screening before the pandemic, made substantial operational changes, including the purchase of a mobile van equipped to provide Pap tests. The center also offered to provide Pap screenings at home visits.
Overall, the researchers found that community health centers were better able to maintain and recover screening services when the following organizational factors were present: prioritization of preventive care, supportive and engaged leadership, quality improvement skills and capacity, and established processes for conducting patient outreach.
Huguet is an associate professor in the Department of Family Medicine in the OHSU School of Medicine. A paper detailing their findings appears in the journal Medical Care.
Data for this study were provided by the ADVANCE Clinical Research Network, which is led by OCHIN, and is supported by the Patient-Centered Outcomes Research Institute (contract RI-OCHIN-01-MC).
This research was supported by National Cancer Institute (grant numbers P50CA244289 and P50CA244289-02S1). This P50 program was launched by NCI as part of the Cancer Moonshot.