Importance of Continued Cancer Screening during a Global Pandemic

There is no denying cancer screening transformed cancer care, as it aims to detect cancer before the appearance of symptoms. Timely screening has proven to be an effective tool in early diagnosis and decreasing cancer mortality rates. With early screening and engagement, health professionals are able to connect with patients sooner and tailor treatment plans to individual screening results and tumor characteristics, ultimately enhancing patient outcomes.

This initial step in cancer care has been dramatically altered due to the global pandemic. The Centers for Medicare & Medicaid Services in the United States have classified screening as a low-priority service and suggest healthcare organizations to consider postponing screenings. Many patients are also fearful of exposure to the COVID-19 virus or of overburdening healthcare services and thus have been less likely to present to healthcare services for cancer screening and diagnosis. As a result, the number of tests to screen for cervical, breast and colon cancer fell by 85% or more after the first COVID-19 cases was diagnosed in the U.S..

85% of Cancer Screenings in US Delayed

Cancer progression has not paused, and the impact of delayed screening may be drastic. The dip in the number of screenings is concerning as it jeopardizes our ability to diagnose disease early. It will also become more challenging for health systems to recover quickly and resume screening and diagnostics the pandemic intensifies and continues over time.

As the world is still in the midst of a global pandemic, healthcare administrators and systems, need to plan and adapt to allow patients to receive regular screening services in a way that minimizes community spread of COVID-19. For instance:

  • COVID-19-free facilities should be ideally located in sites separate from acute-care hospitals
  • If it is not possible to geographically separate  COVID-19 facilities and cancer-care facilities, separate spaces should be designated in mixed-care sites, with dedicated access and admissions processes for patients with cancer
  • Cancer care services should be delivered by a designated team of providers to reduce the risk of exposing COVID-19-free patients and healthcare workers to the virus
  • Patients should be screened with strict rules of admitting, such as only allowing patients with no symptoms suggestive of COVID-19, have self-isolated for 7–14 days, and/or have tested negative for COVID-19 test.  Staff at facilities could be trained to screen patients prior to scheduling appointments and at the time of appointment

It is also important to develop a program of testing and triaging to determine which patients require immediate screening on the basis of clinical need. This may require rescheduling of non-essential follow up visits or diverting these visits to telemedicine if available. Visits past the five-year mark for patients with no evidence of disease or concerning symptoms should be considered for rescheduling when clinical, laboratory, and imaging reports suggest low risk for recurrence.

These changes to screening will require active monitoring of waiting lists, communication with patients remotely, and enhanced communication between providers and facilities. Screening for cancer is a process that involves many moving parts, from primary care clinics, hospitals, and imagining facilities. Health systems will need to adopt new technologies to engage with patients and healthcare teams in a centralized and coordinated manner. As a leading provider of comprehensive care coordination solutions, Equicare Health can facilitate this process.  Equicare Health’s platform bridges the gaps and seamlessly connects health professional team members to each other and their patients

For instance, lung cancer screening programs have been altered during the COVID-19 pandemic as the risks from potential exposure to COVID-19 and resource allocation that has occurred to tackle the pandemic. This has altered the balance of benefits and harms of screening.  Performing a screening examination, and the evaluation of lung nodules, now carries an added risk. To date, health providers and hospital systems have been independently determining how to modify their screening and nodule management programs during the pandemic. For jurisdictions that are of low risk of COVID-19 transmission, Equicare Health’s standardized follow-up template to track lung screening patients and collect data that can be uploaded to the American College of Radiology (ACR) Lung Cancer Screening Registry may be an advantageous tool to minimize the risk of virus transmission.

Additionally, Equicare can help enhance communication with patients and increase their engagement in their care journey through the patient portal. The portal allows patients to connect directly with their care team. For example, patients can respond to electronic questionnaires to facilitate triaging of care. Once in the portal, patients can access individualized information, such as their test results, educational material, as well as their telehealth appointment schedule. Regular visits to the portal will help patients and their caregivers keep up-to-date on the progress of their journey and maintain contact with their care team without physically visiting a healthcare site. This can improve the experience of care for both patients and providers, and helps facilitate the continuation of cancer screening during this global pandemic.  

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses and health systems.

Cancer in the time of COVID-19

The coronavirus disease (COVID-19) continues to spread globally at an alarming rate, influencing all sectors of our society. The burden of COVID-19 on health systems has important implications for cancer prevention and treatment, including:

  1.  an increased risk of infection for cancer patients,
  2.  the suspension of screening, and
  3. the de-prioritization of other cancer care services, including diagnosis and treatment.              

These changes have had and will continue to have a profound impact on the lives of cancer patients and their families, as well as care providers. Patients with cancer are known to be at increased risk for community acquired respiratory viruses due to their immunocompromised state, and are vulnerable to worse outcomes from the infection. They might be more likely to get infections because of the cancer itself, certain cancer treatment modalities, poor nutrition, and other co-morbidities. Patients are also worried about potential exposure to this infectious disease, and have been reluctant to seek health services out of fear that they will be exposed to the virus.

Additionally, many aspects of the cancer care continuum have been suspended to enable health systems to respond to the pandemic. The American Society of Clinical Oncology recommends, “to conserve health system resources and reduce patient contact with health care facilities,… that cancer screening procedures that require clinic/center visits, such as screening mammograms and colonoscopy, be postponed for the time being.”  The dramatic reduction of testing has led to a significant decline in newly identified patients with six common types of cancer.  

While COVID-19 preventive measures, such as social distancing and mask wearing are being taken to control the pandemic, cancer has not paused or slowed down. Cancer care and treatments have been deprioritized – nearly 80% of people in treatment have experienced some delay in care due to the pandemic. This delay will lead to the presentation of more advanced stages of cancer, poorer clinical outcomes, and elevated cancer-related mortality rates.  One study suggests a potential increase of 33, 890 excessive cancer deaths in the United States.

To protect the health of cancer patients during times of high risk, the cancer care team should focus on enhancing communication and care coordination. To minimize risk, patients should be informed about their increased risk of infection, and precautions that need to be taken to decrease the chance of contracting COVID-19. For instance, this could include sharing the US Centers for Disease Control and Prevention’s (CDC) specific recommendations for people at risk for serious illness from COVID-19 infection with patients. In addition to general guidelines, patients need to be aware of individual risk as relative risk is typically case-based and needs to be tailored to the individual. Timely communication between members of the patient’s care team is also crucial to ensure all providers are informed about the care process. Engaging with patients and providing useful information can help alleviate some anxiety around risk of virus exposure and seeking care during a pandemic.

The backlog of patients in need of cancer care could overburden the health system in the years to come. Planning is needed at all decision-making levels to address the backlog and lessen its impact. In addition to the continuous need for cancer research funding and better access to health care and screenings, certain tools and solutions need to be incorporated into care to enhance system efficiencies, including the use of more robust digital technologies.  These technologies include self-service scheduling across cancer care specialties, data collection (i.e. patient-reported outcomes and test results) tools and processes, and telehealth supports.

Equicare Health Inc., the leading provider in oncology care coordination and patient navigation solutions, allows for enhanced communication between healthcare providers, patients and their families through many avenues. This platform allows for patient appointment reminders and automatic assignment of questionnaires to patients based on compliance goals and clinical needs. Patient reported outcomes (PROs) and questionnaires allow self-reporting of symptoms that provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. In addition, care providers can connect with patients and their care team through video conferencing through EQUICARE CONNECT, a secure and cloud-based platform.

These tools have proven that enhanced communication and a well-coordinated system is not only advantageous for the patient, but also the care team, and healthcare system. Inherently, these digital supports will foster positive relationships and trust between all stakeholders involved. Strong connections between patients and providers, as well as within care teams, is critical at all times during the entire cancer care continuum, but even more so during a global pandemic.  

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses and health systems.