Evaluating the impact of the COVID-19 pandemic on colorectal cancer screening within a large, mailed outreach program
Introduction
The American Cancer Society, along with other similar organizations, recommended postponing cancer screening at the start of the COVID-19 pandemic to prioritize more urgent medical needs while also reducing the spread of the disease. In sync with this recommendation was likely also a patient-driven decision to forgo screening reflecting the fear of contracting COVID-19 within a healthcare setting. The coordinated result was a substantial drop in cancer screening that was slow to rebound. While in-home stool-based tests (FIT) represented a safe and effective alternative for colorectcal cancer screening, patients who receive a positive test result still require a follow-up with a colonoscopy within 10 months for maximum benefit. Our Colorectal Cancer Screening and Patient Navigation Program (CSPAN; PP200009) operates as a large mailed FIT outreach program launched its expansion in March 2020 and represents an opportunity to evaluate the immediate effects of the COVID-19 pandemic on colorectal cancer screening.
Methods
We implemented questions as part of a community reengagement campaign in Tarrant County to better understand the influence of the pandemic on screening participation. Specifically, these questions address factors likely to contribute to screening participation, including changes to employment and/or insurance coverage, access to care for children or other family members, as well as previous screening behavior. These data have been extracted alongside program data collected prior to, during, and post-pandemic.
Results
We examined trends in screening volume, including colonoscopy completion following an abnormal FIT result, in combination with patient-reported barriers to screening. Data is available for 1,370 patients invited to completed CRC screening, of which 860 have completed screening. We further summarize the patient-reported barriers to highlight intervention points within the community, particularly in context of those persons most likely to have disengaged from screening due to the pandemic. Lastly, we compare both screening completion along with colonoscopy completion after an abnormal FIT for patients residing in Tarrant County to those living in one of the surrounding 66 counties, where restrictions were not as limiting.
Conclusion
While we anticipate mailed FIT outreach should have reduced any notable effect in screening participation, we also account for delayed invitation at the start of the pandemic in anticipation of reduced capacity for colonoscopy, which is likely more impactful to the low-income population which we serve, where residency is often less stable, and as such still expect reductions in screening participation. Similarly, we expect colonoscopy completion to be influenced both by health system capacity as well as patient reported barriers, yet still anticipate differences in rural vs. urban (Tarrant County) regions in response to variations in restrictions and reopening (capacity).