Understanding disruptions in cancer care to reduce increased cancer burden
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Curated by eLife
eLife assessment
The study presents patterns of cancer care disruption in southern Illinois and eastern Missouri in the summer of 2020. Survey results show factors that impact cancer care during the COVID-19 pandemic, including group differences by race. The important findings provide solid evidence about variation in cancer care disruptions and opportunities to improve return to care.
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Abstract
This study seeks to understand how and for whom COVID-19 disrupted cancer care to understand the potential for cancer health disparities across the cancer prevention and control continuum.
Methods:
In this cross-sectional study, participants age 30+residing in an 82-county region in Missouri and Illinois completed an online survey from June-August 2020. Descriptive statistics were calculated for all variables separately and by care disruption status. Logistic regression modeling was conducted to determine the correlates of care disruption.
Results:
Participants (N=680) reported 21% to 57% of cancer screening or treatment appointments were canceled/postponed from March 2020 through the end of 2020. Approximately 34% of residents stated they would need to know if their doctor’s office is taking the appropriate COVID-related safety precautions to return to care. Higher education (OR = 1.26, 95% CI:1.11–1.43), identifying as female (OR = 1.60, 95% CI:1.12–2.30), experiencing more discrimination in healthcare settings (OR = 1.40, 95% CI:1.13–1.72), and having scheduled a telehealth appointment (OR = 1.51, 95% CI:1.07–2.15) were associated with higher odds of care disruption. Factors associated with care disruption were not consistent across races. Higher odds of care disruption for White residents were associated with higher education, female identity, older age, and having scheduled a telehealth appointment, while higher odds of care disruption for Black residents were associated only with higher education.
Conclusions:
This study provides an understanding of the factors associated with cancer care disruption and what patients need to return to care. Results may inform outreach and engagement strategies to reduce delayed cancer screenings and encourage returning to cancer care.
Funding:
This study was supported by the National Cancer Institute’s Administrative Supplements for P30 Cancer Center Support Grants (P30CA091842-18S2 and P30CA091842-19S4). Kia L. Davis, Lisa Klesges, Sarah Humble, and Bettina Drake were supported by the National Cancer Institute’s P50CA244431 and Kia L. Davis was also supported by the Breast Cancer Research Foundation. Callie Walsh-Bailey was supported by NIMHD T37 MD014218. The content does not necessarily represent the official view of these funding agencies and is solely the responsibility of the authors.
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Author Response
Reviewer #1 (Public Review):
This cross-sectional study examined the results of a survey about cancer treatment disruption during June-August 2020 in 82 counties located in Missouri and Illinois in the U.S. The main outcome was disruption in cancer care. Authors reported that higher education, being a female, experiencing more discrimination in healthcare settings, and having scheduled a telehealth appointment were associated with higher odds of care disruption. Lack of a research focus, lack of following any conceptual framework, the cross-sectional nature of the study, and the small sample size were the noted shortcomings of the manuscript.
We thank Reviewer 1 for their comments. We agree that it is important to understand COVID-related care disruptions using causal methods. However, this manuscript aimed to …
Author Response
Reviewer #1 (Public Review):
This cross-sectional study examined the results of a survey about cancer treatment disruption during June-August 2020 in 82 counties located in Missouri and Illinois in the U.S. The main outcome was disruption in cancer care. Authors reported that higher education, being a female, experiencing more discrimination in healthcare settings, and having scheduled a telehealth appointment were associated with higher odds of care disruption. Lack of a research focus, lack of following any conceptual framework, the cross-sectional nature of the study, and the small sample size were the noted shortcomings of the manuscript.
We thank Reviewer 1 for their comments. We agree that it is important to understand COVID-related care disruptions using causal methods. However, this manuscript aimed to examine the local impact of COVID care disruptions. We focused on the Siteman Cancer Center’s (SCC) catchment area because the co-author team includes the SCC’s Associate Director of Community Outreach and Engagement (COE) program, the SCC Associate Director for Diversity, Equity, and Inclusion, multiple members of the SCC COE leadership team. Thus, we are uniquely positioned to mobilize and identify outreach opportunities and/or programs that address any gaps we discover. Moreover, this focus on our catchment area and the motivation for this survey aligns with the National Cancer Institute’s priorities of population health assessments to characterize cancer-relevant knowledge, attitudes, beliefs, and behaviors across cancer center catchment areas. While this is a crosssectional study, this snapshot of care disruption will be helpful in planning local outreach strategies. Lastly, our catchment area is challenged with multiple cancer disparities patterned by social identities. Therefore, our analysis was guided by the theory that social identities related to race, ethnicity, class, and gender shape access to healthcare and disease processes and are the fundamental drivers of health. Thus, we included variables that impact health and are patterned by these social factors.
Reviewer #2 (Public Review):
Dr. Kia Davis and colleagues present a thoughtful analysis of disruptions to cancer care during COVID-19 in the article, "Understanding disruptions in cancer care to reduce increased cancer burden: a cross-sectional study." The article is based on an online survey of 680 residents in the Siteman Cancer Center catchment area in Summer 2020. The authors aim to characterize demographic differences in cancer care disruptions. Information about the causes and distribution of care disruption can help reduce the impacts of COVID-19 and guide the recovery of programs and services. The article provides a clear and detailed assessment of factors associated with care disruption and return to care during the first six months of the pandemic.
A strength of the study is the focus on the catchment area of the cancer center during a period of dramatic change. The results would provide timely and actionable data to address emerging barriers to care and associated social or contextual factors. This information helps the Community Outreach and Engagement efforts to be responsive to community priorities despite rapidly evolving circumstances.
The analysis would benefit from greater detail in three areas. First, it would be helpful to have more information about how the outcome measures were originally developed or tested. Second, for the regression analysis, it would be helpful to show the demographic characteristics of the two strata to better understand the sample composition. Third, the authors should demonstrate that the data do not violate the assumptions for conducting logistic regression to improve confidence in the findings.
COVID-19 affected all aspects of the cancer continuum. The study reports factors associated with postponing or canceling cancer-related appointments during the pandemic. It will be of great interest to researchers and practitioners in cancer prevention and control.
We thank Reviewer 2 for their thoughtful critique of our work. Their suggestions have strengthened our manuscript. Since our article was submitted, the questionnaire where we derived our outcome measure has been published. The questions were drawn from validated measures assessing the impact of pandemics such as H1N1, and major life disruptions such as natural disasters. This language was updated in the manuscript as were the references. Moreover, we added a supplemental Table 2 to show the demographic characteristics by race strata. Finally, we tested and can confirm that the analysis does not validate the assumptions of logistic regression. We believe that our results will aid in the understanding of how COVID impacted cancer care in our catchment area so that we can better mobilize resources. While we understand this is a cross-sectional study with the potential for unmeasured confounding, we believe this snapshot of cancer care during the pandemic will also be of interest to researchers, clinicians, and other practitioners in cancer prevention and control in locations like ours.
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eLife assessment
The study presents patterns of cancer care disruption in southern Illinois and eastern Missouri in the summer of 2020. Survey results show factors that impact cancer care during the COVID-19 pandemic, including group differences by race. The important findings provide solid evidence about variation in cancer care disruptions and opportunities to improve return to care.
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Reviewer #1 (Public Review):
This cross-sectional study examined the results of a survey about cancer treatment disruption during June-August 2020 in 82 counties located in Missouri and Illinois in the U.S. The main outcome was disruption in cancer care. Authors reported that higher education, being a female, experiencing more discrimination in healthcare settings, and having scheduled a telehealth appointment were associated with higher odds of care disruption. Lack of a research focus, lack of following any conceptual framework, the cross-sectional nature of the study, and the small sample size were the noted shortcomings of the manuscript.
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Reviewer #2 (Public Review):
Dr. Kia Davis and colleagues present a thoughtful analysis of disruptions to cancer care during COVID-19 in the article, "Understanding disruptions in cancer care to reduce increased cancer burden: a cross-sectional study." The article is based on an online survey of 680 residents in the Siteman Cancer Center catchment area in Summer 2020. The authors aim to characterize demographic differences in cancer care disruptions. Information about the causes and distribution of care disruption can help reduce the impacts of COVID-19 and guide the recovery of programs and services. The article provides a clear and detailed assessment of factors associated with care disruption and return to care during the first six months of the pandemic.
A strength of the study is the focus on the catchment area of the cancer center …
Reviewer #2 (Public Review):
Dr. Kia Davis and colleagues present a thoughtful analysis of disruptions to cancer care during COVID-19 in the article, "Understanding disruptions in cancer care to reduce increased cancer burden: a cross-sectional study." The article is based on an online survey of 680 residents in the Siteman Cancer Center catchment area in Summer 2020. The authors aim to characterize demographic differences in cancer care disruptions. Information about the causes and distribution of care disruption can help reduce the impacts of COVID-19 and guide the recovery of programs and services. The article provides a clear and detailed assessment of factors associated with care disruption and return to care during the first six months of the pandemic.
A strength of the study is the focus on the catchment area of the cancer center during a period of dramatic change. The results would provide timely and actionable data to address emerging barriers to care and associated social or contextual factors. This information helps the Community Outreach and Engagement efforts to be responsive to community priorities despite rapidly evolving circumstances.
The analysis would benefit from greater detail in three areas. First, it would be helpful to have more information about how the outcome measures were originally developed or tested. Second, for the regression analysis, it would be helpful to show the demographic characteristics of the two strata to better understand the sample composition. Third, the authors should demonstrate that the data do not violate the assumptions for conducting logistic regression to improve confidence in the findings.
COVID-19 affected all aspects of the cancer continuum. The study reports factors associated with postponing or canceling cancer-related appointments during the pandemic. It will be of great interest to researchers and practitioners in cancer prevention and control.
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