The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study
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The authors used the Multiethnic Cohort (MEC) study to study how COVID-19 impacted access to cancer screenings and treatment. This study's important findings served to identify key factors associated with cancer-related screening and healthcare-seeking during the pandemic. This investigation provides solid evidence to inform future policies, particularly in older and vulnerable populations.
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Abstract
The Coronavirus Disease of 2019 (COVID-19) has impacted the health and day-to-day life of individuals, especially the elderly and people with certain pre-existing medical conditions, including cancer. The purpose of this study was to investigate how COVID-19 impacted access to cancer screenings and treatment, by studying the participants in the Multiethnic Cohort (MEC) study.
Methods:
The MEC has been following over 215,000 residents of Hawai‘i and Los Angeles for the development of cancer and other chronic diseases since 1993–1996. It includes men and women of five racial and ethnic groups: African American, Japanese American, Latino, Native Hawaiian, and White. In 2020, surviving participants were sent an invitation to complete an online survey on the impact of COVID-19 on their daily life activities, including adherence to cancer screening and treatment. Approximately 7,000 MEC participants responded. A cross-sectional analysis was performed to investigate the relationships between the postponement of regular health care visits and cancer screening procedures or treatment with race and ethnicity, age, education, and comorbidity.
Results:
Women with more education, women with lung disease, COPD, or asthma, and women and men diagnosed with cancer in the past 5 years were more likely to postpone any cancer screening test/procedure due to the COVID-19 pandemic. Groups less likely to postpone cancer screening included older women compared to younger women and Japanese American men and women compared to White men and women.
Conclusions:
This study revealed specific associations of race/ethnicity, age, education level, and comorbidities with the cancer-related screening and healthcare of MEC participants during the COVID-19 pandemic. Increased monitoring of patients in high-risk groups for cancer and other diseases is of the utmost importance as the chance of undiagnosed cases or poor prognosis is increased as a result of delayed screening and treatment.
Funding:
This research was partially supported by the Omidyar 'Ohana Foundation and grant U01 CA164973 from the National Cancer Institute.
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eLife assessment
The authors used the Multiethnic Cohort (MEC) study to study how COVID-19 impacted access to cancer screenings and treatment. This study's important findings served to identify key factors associated with cancer-related screening and healthcare-seeking during the pandemic. This investigation provides solid evidence to inform future policies, particularly in older and vulnerable populations.
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Reviewer #1 (Public Review):
The purpose of this study was to investigate within the diverse Multiethnic Cohort (MEC) study on how COVID-19 impacted access to cancer screenings and treatment through a cross-sectional survey in this study population.
Major strengths were leveraging existing participants in a cohort study that contained a diverse population. The MEC cohort participants have been studied since the 90's. The investigators used a well-designed survey and performed analysis on responses focused on cancer screening attendance. Weaknesses of this study are low response rates that make the results not generalizable to other populations, especially younger populations, and possible bias of specific types of individuals responding.
This study found associations with racial/ethnic, age, comorbidities, and education to be key …
Reviewer #1 (Public Review):
The purpose of this study was to investigate within the diverse Multiethnic Cohort (MEC) study on how COVID-19 impacted access to cancer screenings and treatment through a cross-sectional survey in this study population.
Major strengths were leveraging existing participants in a cohort study that contained a diverse population. The MEC cohort participants have been studied since the 90's. The investigators used a well-designed survey and performed analysis on responses focused on cancer screening attendance. Weaknesses of this study are low response rates that make the results not generalizable to other populations, especially younger populations, and possible bias of specific types of individuals responding.
This study found associations with racial/ethnic, age, comorbidities, and education to be key factors associated with cancer-related screening and healthcare seeking during the COVID-19 pandemic.
Whether the associations observed by the investigators would remain over time is unknown, as health care seeking changed as the pandemic evolved and prevention tools (including mass testing and vaccination) became available. It is important to note that this is a snapshot in time, so while it is informative, it will be important to monitor whether certain groups/populations that may be at high risk for cancer may need to be targeted for early diagnosis and screening.
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