Colorectal cancer screening is essential for early detection and treatment. However, the COVID-19 pandemic created unique barriers to these vital screenings. Pandemic-related shutdowns led to lower engagement in preventative healthcare services, including colonoscopies. It also reduced access to care, particularly for those already vulnerable due to race, insurance status, and socioeconomic status. Furthermore, many individuals may have been hesitant to seek medical care due to concerns about exposure to COVID-19 in healthcare settings, leading to delays in routine screenings.
New research from the Providence health system offers valuable insights into how the pandemic affected colorectal cancer screenings and survival, as well as disparities in care. The studies were recently recognized with top honors at two industry events.
Delays in colonoscopy screening & their impact on survival: analysis from an integrated healthcare system
In a study led by experts from the Saint John’s Cancer Institute, Saint John's Digestive Health Institute, and the Providence Research Network, investigators evaluated data from 52 inpatient and 800 ambulatory facilities in seven western states to determine whether pandemic-related delays in colonoscopy screening impacted survival. They found that:
The pandemic led to both a decrease and delay in screening colonoscopies.
- Patients diagnosed with screen-detected colorectal cancer in the post-COVID period had worse overall survival compared to those diagnosed in the pre-COVID period.
- Pre-pandemic disparities in outcomes persisted in the post-COVID interval and, even when controlling for age, gender, race, and insurance status, the post-COVID period remained an independent risk factor for worse overall survival.
“The COVID-19 pandemic created a unique opportunity to use pandemic-related closures as a natural experiment to understand what happens in the absence of preventive care,” explains Staci Wendt, senior manager, Pioneer research program, Providence. “As our results showed, screening colonoscopy is an important tool to increase survivability; when screenings either don’t happen or are delayed, we see significant declines in survival.”
Dr. Jessica Weiss, fellow, complex general surgical oncology at Providence Saint John’s Cancer Institute, and Dr. Anton Bilchik, chief of the gastrointestinal research program, presented these and other key findings at the annual meeting of the Pacific Coast Surgical Association (PCSA) in February 2023 and received a first-place award in the prestigious PCSA Resident’s Competition.
Racial & socioeconomic disparities in CRC screening during the COVID-19 pandemic
A second study drawing on Providence medical record data sought to evaluate whether pandemic-related reductions in access to care disproportionately impacted screenings among specific racial populations or socioeconomic groups. The researchers looked at factors including demographics, insurance type, and four domains of the social vulnerability index (SVI): socioeconomic status, household composition/disability, minority status/language, and housing/transportation. Key findings include:
- During the post-COVID-19 period, patients screened were more likely to be commercially insured, urban residents, male, white, and less vulnerable.
- Across three of four SVI domains evaluated as part of the study, all races screened within the post-COVID-19 period demonstrated less vulnerability.
- Vulnerable individuals across racial distributions were screened less in the post-COVID-19 period.
- Native American/Alaska Native races had the lowest screening rates and worse overall survival pre- and post-COVID compared to other races.
- Factors like insurance types or socioeconomic status could not explain a disproportionate drop in screenings among Asian populations.
Dr. Laura Fluke, fellow, complex general surgical oncology at Saint John’s Cancer Institute, and Dr. Bilchik presented the study's findings at the March 2023 annual meeting of the Society of Surgical Oncology and were awarded Top Paper in Disparities in Surgical Oncology Care.
“These studies highlight the importance and potential impact we can have when clinicians and researchers work together to understand trends and outcomes in patient data,” adds Wendt. “The results also highlight the strength of our consolidated electronic medical record system to generate evidence that can be used to transform care, in this case highlighting the importance of access to colorectal cancer screening options.”
Overall, this body of research underscores the importance of understanding the impact of the pandemic on healthcare, particularly among vulnerable populations. The studies provide valuable insights into how the pandemic affected colorectal cancer screening and survival, as well as disparities in care. The findings highlight the need for continued research and efforts to ensure that all patients receive timely and equitable access to screening and care.
The researchers expect these studies will be published in peer-reviewed journals later in 2023.
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