Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population

Lee, Jeffrey K.; Lam, Angela Y.; Jensen, Christopher D.; Marks, Amy R.; Badalov, Jessica; Layefsky, Evan; Kao, Kevin T.; Ho, Ngoc J.; Schottinger, Joanne E.; Ghai, Nirupa R.; Carlson, Cheryl M.; Halm, Ethan A.; Green, Beverly B.; Li, Dan; Corley, Douglas A.; Levin, Theodore R.

doi:10.1053/j.gastro.2022.05.014

Cited by 24 publications

(25 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 23 ). However, a smaller decrease in colorectal cancer diagnosis of 8.7% was found in a cohort study in Kaiser Permanente Northern California patients ( 24 ), probably due to their high reliance on FIT screening, for which utilization rates remained relatively high during the pandemic. More recent data also show that screening rates were still lagging behind in June 2021 ( 25 ).…”

Section: Discussionmentioning

confidence: 94%

Impact and Recovery from COVID-19–Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis

Puttelaar

Lansdorp–Vogelaar

Hahn

et al. 2022

Cancer Epidemiology, Biomarkers &Amp; Prevention

Self Cite

View full text Add to dashboard Cite

Background: Many colorectal cancer (CRC)-related procedures were suspended during the COVID-19 pandemic. In this study, we predict the impact of resulting delays in screening (colonoscopy, FIT, sigmoidoscopy) and diagnosis on CRC outcomes, and compare different recovery scenarios. Methods: Using the MISCAN-Colon model, we simulated the US population and evaluated different impact and recovery scenarios. Scenarios were defined by the duration and severity of the disruption (% of eligible adults affected), the length of delays, and the duration of the recovery. During recovery (6, 12 or 24 months), capacity was increased to catch up missed procedures. Primary outcomes were excess CRC cases and deaths, and additional colonoscopies required during recovery. Results: With a 24-month recovery, the model predicted that the US population would develop 7,210 (0.18%) excess CRC cases during 2020-2040, and 6,950 (0.65%) excess CRC deaths, and require 108,500 (8.6%) additional colonoscopies per recovery month, compared to a no-disruption scenario. Shorter recovery periods of 6 and 12 months, respectively, decreased excess CRC deaths to 4,190 (0.39%) and 4,580 (0.43%), at the expense of 260,200-590,100 (20.7-47.0%) additional colonoscopies per month. Conclusions: The COVID-19 pandemic will likely cause more than 4,000 excess CRC deaths in the US, which could increase to more than 7,000 if recovery periods are longer. Impact: Our results highlight that catching-up CRC services within 12 months provides a good balance between required resources and mitigation of the impact of the disruption on CRC deaths.

show abstract

Section: Discussionmentioning

confidence: 94%

Impact and Recovery from COVID-19–Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis

Puttelaar

Lansdorp–Vogelaar

Hahn

et al. 2022

Cancer Epidemiology, Biomarkers &Amp; Prevention

Self Cite

View full text Add to dashboard Cite

show abstract

“…12 This interruption in the continuum of care among FQHC patients is particularly alarming given that access to GI visits has been restricted because of the COVID-19 pandemic. [41][42][43][44][45][46] Community clinics report a 5% point decrease-from 45% in 2019 to 40% in 2020-in CRC screening rates. 41 The pandemic-related backlog, combined with recent changes to US Preventive Services Task Force guidelines recommending initiation of screening at age 45 rather than age 50 (impacting roughly 20 million adults aged 45-49), has increased demand for screening and follow-up services at a time when community clinics are struggling with colonoscopy backlog for those aged 50 and older.…”

Section: Discussionmentioning

confidence: 99%

“…41 The pandemic-related backlog, combined with recent changes to US Preventive Services Task Force guidelines recommending initiation of screening at age 45 rather than age 50 (impacting roughly 20 million adults aged 45-49), has increased demand for screening and follow-up services at a time when community clinics are struggling with colonoscopy backlog for those aged 50 and older. 37,43…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy Following an Abnormal Fecal Test Result from an Annual Colorectal Cancer Screening Program in a Federally Qualified Health Center

Escaron

Garcia

Petrik

et al. 2022

J Prim Care Community Health

View full text Add to dashboard Cite

Objective: Individuals with an abnormal fecal immunochemical test (FIT) result have an elevated risk of colorectal cancer, and the risk increases if the follow-up colonoscopy is delayed. Of note, rates of follow-up colonoscopy are alarmingly low in federally qualified health centers (FQHCs), US health care settings that serve a majority racial and ethnic minority patient population. We assessed factors associated with colonoscopy after an abnormal FIT result and used chart-abstracted data to assess reasons (including process measures) for lack of follow-up as part of an annual, mailed-FIT outreach program within a large, Latino-serving FQHC. Methods: As part of the National Institutes of Health-funded PROMPT study, we identified patients with an abnormal FIT result and used logistic regression to assess associations between patient demographics and receipt of follow-up colonoscopy, controlling for patients’ preferred language. We report on time (days) to referral and time to colonoscopy. For charts with an abnormal FIT result but no evidence of colonoscopy, we performed a manual abstraction and obtained the reason for the absence of colonoscopy. When there was no evidence of colonoscopy in a patient’s electronic health record (EHR), we performed an automated query of the administrative claims database to identify colonoscopy outcomes. Results: We identified 324 patients with abnormal FIT results from July to October 2018. These patients were mostly publicly insured (Medicaid 53.1%, Medicare 14.5%), 81.8% were aged 50 to 64 years, 55.3% were female, 80.3% were Hispanic/Latino, and 67.3% preferred to speak Spanish. We found that 108/324 (33.3%) patients completed colonoscopy within 12 months, and the median time to colonoscopy was 94 days (IQR: 68-176). Common barriers to colonoscopy completion, obtained from chart-abstracted data, were: no documentation following referral to gastrointestinal (GI) specialist or GI consultation (41.6%), no referral to GI specialist following abnormal fecal test (34.2%), and absence of a valid insurance authorization (6.5%). Conclusions: Multi-level strategies are needed to provide optimal care across the cancer continuum for FQHC patients. In order to reduce the risk of CRC and realize the return on fecal testing investment, concerted system-level efforts are urgently needed to improve rates of follow-up colonoscopy among FQHC patients and redress racial and ethnic disparities in CRC screening outcomes.

show abstract

“…Patients were divided into Group Previous and Group Later based on the chronological relationship between the date of admission and the start of the lockdown; according to the chronological relationship between the date of discharge and the duration of lockdown, patients were divided into Group Before, Group During and Group After. Patients were divided into two groups according to whether the patient had a systemic disease that may affect the recovery, such as anemia [17], leukopenia [18], liver fibrosis [19], diabetes [20], etc.…”

Section: Methodsmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on Inpatient Surgical Treatment in Patients with Benign Anorectal Diseases

2023

IJHPM

View full text Add to dashboard Cite

Background: The reconstruction of anorectal surgery in the context of COVID-19 pandemic is ongoing. Objective: This study aims to examine the impact of COVID-19 pandemic on inpatient surgical treatment in patients with benign anorectal diseases. Design: This was a retrospective, single-center, observational study. Settings: The study was conducted in a hospital affiliated to a provincial medical university in China. Patients: This study included patients admitted from December of the last three years to March of the following year (total 1353). Main outcome measures: The patients' gender, age, first diagnosis, main symptoms and their worse days, pre-admission treatment, date of admission and discharge, length of hospital days, straight-line distance between residence and the hospital, and comorbidities were recorded. Results: Lockdown led to a decline in admissions, a reduction of hospital days (p<0.001), and changes in the proportion of different diseases admissions (p=0.032). The distance between residence and the hospital was reduced. Each wave of the outbreak was associated with prolonged hospital days. The hospital stay was not significantly affected in patients with colorectal polyps (p=0.564), but their number of hospital admissions greatly reduced. Limitations: This study was limited by the limited number of patients during the lockdown period and the lack of data about outpatient and unadmitted patients. Conclusions: The reconstructive process in colorectal surgery remains fraught with difficulties. The determinant of patient admission is the urgency and severity of the symptoms. Pre-admission treatment was not significantly affected. Care should be given to possible adverse outcomes due to reduced admissions for colorectal polyps. Lockdown causes shorter hospital stays over a short time, but the outbreaks still causes longer hospital stays over the relatively long term. To accelerate reconstruction, outpatient treatment should return to normal as soon as possible.

show abstract

Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population

Cited by 24 publications

References 21 publications

Impact and Recovery from COVID-19–Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis

Impact and Recovery from COVID-19–Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis

Colonoscopy Following an Abnormal Fecal Test Result from an Annual Colorectal Cancer Screening Program in a Federally Qualified Health Center

The Impact of COVID-19 Pandemic on Inpatient Surgical Treatment in Patients with Benign Anorectal Diseases

Contact Info

Product

Resources

About