Covid Delayed Cancer Screenings: How Will it Affect Us Long Term?

With the shutdowns of medical facilities during Covid and limited availability for routine cancer screening and heart and lung testing, what will be the outcome? We may be back to full functioning healthcare, but patients are still afraid of hospitals and emergency rooms.

Covid Delayed Cancer Screenings: How Will it Affect Us Long Term?

It makes sense that patients have put off getting a mammogram, colonoscopy, heart tests, etc. due to the Covid epidemic. Since the beginning of the pandemic, we have seen many services become limited and together with the fear of contamination, has led to a delay in care that we will not see the effects of for several years. Unfortunately, the media focuses on the drama, which feeds into anxiety and stress already surrounding healthcare. 

Taking care of Covid patients shunted resources away from other diseases like cancer1. It took us by surprise, and we weren’t prepared for the severity and long-term care that it created. Across the world, tests were temporarily stopped, which created a large number of patients waiting for testing or screening such as a colonoscopy1. Several governments globally put their citizens on lockdown, causing a decrease in the number of people going to the doctor for urgent issues and chemotherapy1. 

Something not in the forefront of the news, or even our thoughts as nurses (unless you work in research), is the number of clinical trials that were deferred or stopped altogether due to Covid1. The outcome for these patients is something we won’t have the complete data on for a long time. It must have been difficult for those patients in the middle of treatment, especially chemo patients, to have their treatment halted. To have hope that a drug might help decrease a symptom, or help their cancer only to have their expectation dashed, must have been emotionally and physically devastating.

One good thing that has come out of the epidemic is the use of at-home testing, such as the fecal immunochemical test (FIT)3. This test can be mailed to the person, collected and mailed back to the company who then sends a result to the doctor. There are not many at-home tests right now, but the FIT is being modeled for other testing, such as one for cervical cancer3. Cancer screenings that are recommended are cervical, lung, colorectal, and breast3. It is impossible to know how many patients have not gotten screened for one or all of these cancers, depending on their risk factors. Some cancers are slow growing, and some are fast growing, so the number of deaths that result from lack of screening will not be known for many years3. 

Patients that were screened at Massachusetts General at the beginning of the pandemic 3/2/20 to 6/2/20 were 15,453, and 1,985 of those were diagnosed with cancer3.  This was a dramatic drop from the previous year 3/2/19 to 6/2/19, with 60,344 patients screened and 2,961 that were diagnosed positive. After the initial drop in patients coming in for screenings, the numbers went back up to close to pre-covid numbers (6/3/20 to 9/3/20 51,944 were screened, and 3,190 tested positive)3. 

While these numbers are encouraging that patients went back to the doctor, what about the ones who didn’t, or the ones who still are afraid of hospitals or clinics?

In my experience at a GI lab that also does bronchs, I saw the pulmonologists busy with ICU care to the point that they put off office visits for months. They were too busy to do it all and were working around the clock just to keep up with the hospital, especially ICU patients. 

At the University of Cincinnati:

 “In March 2020 alone, COVID-19 forced the postponement of more than 800 appointments for lung cancer screening. But when screening fully resumed on June 1, the percentage of people tested who had lung nodules that were suspicious for cancer had increased from 8% before the pandemic to 29%”3. 

For most doctors' offices, clinics, and hospital procedures, there are higher than average “no shows” or cancellations of appointments3. We see that at our GI lab, most days, there is at least one no-show for a procedure. The GI doctors also tell us that this is happening in their clinic as well. Financially, this is impacting the healthcare system in general. The problem is getting the word out to patients that it is safe to resume normal screenings3. Besides the fear, many people feel that their screenings can wait. Because of this, doctors have been seeing cancers that are more severe due to patients putting off doctor visits3. 

Telemedicine has had its place during the pandemic; in fact, it has expanded and become very useful. The problem is that it is difficult to assess cancer without a hands-on evaluation and testing3. Patients are afraid to go to the doctor's office and emergency room, so, therefore, are going un-diagnosed with cancer. This patient group isn’t just missing a new diagnosis; they may have exacerbated disease processes as well, such as diabetes or COPD that gets out of control because they are afraid to visit the doctor. A year ago in January, “40% of Americans still do not feel safe going to the doctor’s office”4. Hopefully, at this point, that number is smaller. 

The number of heart attacks and strokes saw an increase in the first year post Covid4. This delay in care results in long hospital stays, more procedures, and a higher mortality rate. It is very important for patients to continue check ups and not to ignore their health. 

Veterans are one of the high risk categories because of some of the chemicals that they are exposed to. According to the article, “Routine Cancer Screening Delays Due to Pandemic at Veteran Affairs,” by Kidwai, between 2019 and 2020, Mammograms screenings went down 12%, Colonoscopy screenings went down 55%, and Low Dose CT screenings went down 49%2. This delay in screenings for cancer will eventually be realized in poor outcomes and higher mortality2. 

The United States healthcare system has put a lot of money and effort into educating people on the importance of cancer screenings such as pap smears, mammograms, prostate exams, colonoscopies, and CT scans for lung cancer. There have been fewer deaths in previous years from cancer because of this. Covid has set our healthcare system back in several areas. Resources are depleted, screenings and treatment delayed, and ongoing fear and low health literacy contribute to the increase in progressive disease process. There are a lot of variables in the post-Covid healthcare world. A lot of them are not able to be measured, which makes it difficult to predict outcomes. Rather than a constant barrage of fear and negativity, the media and our government should start focusing on keeping people healthy by encouraging and educating them to see their doctor and get their cancer screenings. 

There are so many factors to consider in our present healthcare atmosphere: a  lack of resources, the high risk patient population, and environmental conditions. Nurses are a large part of the healthcare system, so we should help our patients understand the importance of paying attention to their symptoms and keeping doctor appointments. We have a voice within our community and a responsibility to help patients move forward. 

Have you put off any screenings due to Covid?

Have you seen an increase in cancer diagnoses among your patients?

References

1 The impact of COVID-19 on cancer screening and treatment

2Routine cancer screening delays due to pandemic at veteran affairs

3For Cancer Screening, COVID-19 Pandemic Creates Obstacles, Opportunities

4SCAI Study Shows COVID Fears Continue to Cause Americans to Avoid Doctor Visits

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Brenda F. Johnson

About Brenda F. Johnson, MSN

Gastrointestinal Columnist

Brenda F. Johnson, BSN, RN Specialty: 25 years of experience in Gastrointestinal Nursing

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Good Article.

I did see on the news 2 days ago that women's cervical cancer rates have gone up.  This could be related to the Covid pandemic, I'm quite sure a lot of health issues will be on the rise now that we are gaining some sense of normalcy.  Personally, I'm not due for any screenings but my mom goes to her screenings.  She loves it and hates it.  If I were not there for her, I could see her becoming frustrated.  One doctor tells her one thing and another doctor tells her something else.  Specialist don't always work together as much as we think they do.  For instance, my mom went to here PCP's office, and they told her to start a blood pressure pill even though she didn't have high blood pressure ever, because it just happened to be high in their office.  This is before seeing any cardiologist whom they referred her to and has since cleared her, but she still has these blood pressure pills.  In her primary office they have a diagnosis of high blood pressure because they prescribed these pills so depending on which doctor sees her, they assume she's taking these blood pressure pills which she has to explain that she doesn't need any more since she's been cleared, yet that diagnosis is still there.  This is an oversimplification that has to deal with one diagnosis and one medication.  But just imagine the patients with other comorbidities and serious medical illnesses who have numerous medications and several specialists who are constantly adding, stopping, changing, increasing this or decreasing that.  I wrote this to say that while it may be easy for us to understand and navigate the healthcare system.  It is sometimes complex and overwhelming for our parents and other older adult patients who have to be told to go here and go there, do this and don't do that.  Are you taking this or that, and if not, why?  

Yes, I think we definitely do an excellent job advocating and assisting our patients, but these are real people with real lives, trying to enjoy the rest of their lives.  Us as Providers need to think better about how we are managing our patients.  We need to take a little extra time to try and listen and understand what we are asking of them so that we can streamline these processes better without making them feel confused and overwhelmed. They have lives too.   Lastly, this goes without saying but we need to ensure we come to them with a sense of understanding and empathy so that we are effective.  This often times allows them to feel as though they are being treated with dignity and respect and not as if they are just a body.

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Specializes in Gastrointestinal Nursing.
On 8/24/2022 at 2:02 PM, HiddenAngels said:

Good Article.

I did see on the news 2 days ago that women's cervical cancer rates have gone up.  This could be related to the Covid pandemic, I'm quite sure a lot of health issues will be on the rise now that we are gaining some sense of normalcy.  Personally, I'm not due for any screenings but my mom goes to her screenings.  She loves it and hates it.  If I were not there for her, I could see her becoming frustrated.  One doctor tells her one thing and another doctor tells her something else.  Specialist don't always work together as much as we think they do.  For instance, my mom went to here PCP's office, and they told her to start a blood pressure pill even though she didn't have high blood pressure ever, because it just happened to be high in their office.  This is before seeing any cardiologist whom they referred her to and has since cleared her, but she still has these blood pressure pills.  In her primary office they have a diagnosis of high blood pressure because they prescribed these pills so depending on which doctor sees her, they assume she's taking these blood pressure pills which she has to explain that she doesn't need any more since she's been cleared, yet that diagnosis is still there.  This is an oversimplification that has to deal with one diagnosis and one medication.  But just imagine the patients with other comorbidities and serious medical illnesses who have numerous medications and several specialists who are constantly adding, stopping, changing, increasing this or decreasing that.  I wrote this to say that while it may be easy for us to understand and navigate the healthcare system.  It is sometimes complex and overwhelming for our parents and other older adult patients who have to be told to go here and go there, do this and don't do that.  Are you taking this or that, and if not, why?  

Yes, I think we definitely do an excellent job advocating and assisting our patients, but these are real people with real lives, trying to enjoy the rest of their lives.  Us as Providers need to think better about how we are managing our patients.  We need to take a little extra time to try and listen and understand what we are asking of them so that we can streamline these processes better without making them feel confused and overwhelmed. They have lives too.   Lastly, this goes without saying but we need to ensure we come to them with a sense of understanding and empathy so that we are effective.  This often times allows them to feel as though they are being treated with dignity and respect and not as if they are just a body. 

I love your input, and agree with it. The healthcare system is set up for duplication, fraud, and not enough oversight. Thank you for your comments

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Specializes in Psych, Addictions, SOL (Student of Life).

I have to say Iput off most of my screenings as my 2nd Shingles vaccine. Due to how busy we were with Covid patients. So on Friday (On mt day off) I saw my pain management team, Got my second Moderna booster and had a mammogram. Mt new Doc tole me I only need a pap every three years due to having negavie tests since I was a teenager. It was a busy day!!

Hppy

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The reasons for patient changes in behavior regarding health care utilization are, in my view, much broader and deeper than simply the fear of catching Covid/being exposed to Covid in a health care facility, but, so far, health care facilities focus and media focus that I am aware of seems to still be mostly on trying to reassure patients that health care facilities take great measures to ensure the health care environment is as free from Covid as possible (the presumption seeming to be that it is primarily the fear of catching Covid that is resulting in patients' decreased utilization of health care facilities).  

 

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Specializes in NICU, PICU, Transport, L&D, Hospice.

People get used to not having copay and deductible bills to pay for routine health care screenings or tests. They begin to enjoy not planning around medical appointments made months in advance. 

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