Abstract

Background: 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 Support: 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.

Data availability

The data that support the findings of this study are openly available on Open Science Framework at https://osf.io/p5x3s/. Please cite as data from this publication if used.

The following data sets were generated

Article and author information

Author details

  1. Kia L Davis

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    For correspondence
    DavisKL@wustl.edu
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-1338-3018
  2. Nicole Ackermann

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-7411-3233
  3. Lisa M Klesges

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    Competing interests
    Lisa M Klesges, has received consulting fees from Dana Farber Cancer Institute. The author is on the Board of Directors for American College of Epidemiology and Neighborhood Preservation, Inc. The author has no other competing interests to declare..
  4. Nora Leahy

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    Competing interests
    No competing interests declared.
  5. Callie Walsh-Bailey

    Brown School, Washington University in St. Louis, St Louis, United States
    Competing interests
    No competing interests declared.
  6. Sarah Humble

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-0694-091X
  7. Bettina Drake

    Department of Surgery, Washington University in St. Louis, St Louis, United States
    Competing interests
    No competing interests declared.
  8. Vetta L Sanders Thompson

    Brown School, Washington University in St. Louis, St Louis, United States
    Competing interests
    Vetta L Sanders Thompson, has received consulting fees from Novaris and Chan-Zuckerburg Initiave via National Academies of Science. The author has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from St. Jude Hospital, Scholar Strategies, University of Missouri St. Louis, Ohio State University Health Services and Management Program Management Institute Annual Conference, and Nebraska Conference on Health Equity Key Note. The author is a Board Director, Vice Chair and Programmatic Strategies Chairperson for Missouri Foundation for Health, and the author receives no financial compensation for these roles. The author has no other competing interests to declare..

Funding

National Cancer Institute (P50CA244431)

  • Kia L Davis
  • Lisa M Klesges
  • Sarah Humble
  • Bettina Drake

National Institute on Minority Health and Health Disparities (T37 MD014218)

  • Callie Walsh-Bailey

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: The Washington University in St. Louis, MO Institutional Review Board approved and exempted this study (ID#202006089). Informed consent was obtained before the survey was administered. All participants received an agreed-upon incentive from Qualtrics.

Reviewing Editor

  1. Eduardo L Franco, McGill University, Canada

Version history

  1. Received: November 18, 2022
  2. Preprint posted: December 28, 2022 (view preprint)
  3. Accepted: August 8, 2023
  4. Accepted Manuscript published: August 10, 2023 (version 1)
  5. Version of Record published: August 24, 2023 (version 2)

Copyright

© 2023, Davis et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Kia L Davis
  2. Nicole Ackermann
  3. Lisa M Klesges
  4. Nora Leahy
  5. Callie Walsh-Bailey
  6. Sarah Humble
  7. Bettina Drake
  8. Vetta L Sanders Thompson
(2023)
Understanding disruptions in cancer care to reduce increased cancer burden
eLife 12:e85024.
https://doi.org/10.7554/eLife.85024

Further reading

    1. Epidemiology and Global Health
    2. Medicine
    Jeffrey Thompson, Yidi Wang ... Ulrich H von Andrian
    Research Article Updated

    Background:

    Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high disease burden and emergence of viral variants. Repurposing of existing therapeutics that prevent or mitigate severe COVID-19 could help to address these challenges. The objective of this study was to determine whether prior use of bisphosphonates is associated with reduced incidence and/or severity of COVID-19.

    Methods:

    A retrospective cohort study utilizing payer-complete health insurance claims data from 8,239,790 patients with continuous medical and prescription insurance January 1, 2019 to June 30, 2020 was performed. The primary exposure of interest was use of any bisphosphonate from January 1, 2019 to February 29, 2020. Bisphosphonate users were identified as patients having at least one bisphosphonate claim during this period, who were then 1:1 propensity score-matched to bisphosphonate non-users by age, gender, insurance type, primary-care-provider visit in 2019, and comorbidity burden. Main outcomes of interest included: (a) any testing for SARS-CoV-2 infection; (b) COVID-19 diagnosis; and (c) hospitalization with a COVID-19 diagnosis between March 1, 2020 and June 30, 2020. Multiple sensitivity analyses were also performed to assess core study outcomes amongst more restrictive matches between BP users/non-users, as well as assessing the relationship between BP-use and other respiratory infections (pneumonia, acute bronchitis) both during the same study period as well as before the COVID outbreak.

    Results:

    A total of 7,906,603 patients for whom continuous medical and prescription insurance information was available were selected. A total of 450,366 bisphosphonate users were identified and 1:1 propensity score-matched to bisphosphonate non-users. Bisphosphonate users had lower odds ratios (OR) of testing for SARS-CoV-2 infection (OR = 0.22; 95%CI:0.21–0.23; p<0.001), COVID-19 diagnosis (OR = 0.23; 95%CI:0.22–0.24; p<0.001), and COVID-19-related hospitalization (OR = 0.26; 95%CI:0.24–0.29; p<0.001). Sensitivity analyses yielded results consistent with the primary analysis. Bisphosphonate-use was also associated with decreased odds of acute bronchitis (OR = 0.23; 95%CI:0.22–0.23; p<0.001) or pneumonia (OR = 0.32; 95%CI:0.31–0.34; p<0.001) in 2019, suggesting that bisphosphonates may protect against respiratory infections by a variety of pathogens, including but not limited to SARS-CoV-2.

    Conclusions:

    Prior bisphosphonate-use was associated with dramatically reduced odds of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalizations. Prospective clinical trials will be required to establish a causal role for bisphosphonate-use in COVID-19-related outcomes.

    Funding:

    This study was supported by NIH grants, AR068383 and AI155865, a grant from MassCPR (to UHvA) and a CRI Irvington postdoctoral fellowship, CRI2453 (to PH).

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