Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers

Abstract

Background: The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. Objectives: To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. Research Design: Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March–May 2020, June–October 2020, and November 2020–September 2021. Subjects: Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. Measures: Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. Results: The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224–0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208–0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125–0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. Conclusions: Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.

Factors contributing to differences in cervical cancer screening in rural and urban community health centers

“…4,5 CHCs can play an important role in preventive care and cancer control. [6][7][8][9][10][11] In a nationally representative study, for example, among people living within 20 miles of a CHC, patients were more likely to receive breast cancer screening than individuals receiving care elsewhere, particularly among people without health insurance. 7 Similar to many other cancer types, cervical cancer mortality rates in the United States have generally been higher in rural and nonmetropolitan areas than urban and metropolitan areas.…”

“…Previous studies found an overall decline in the receipt of cancer screening among CHC patients in the first year of the pandemic but did not report the trends for rural and urban CHCs. [8][9][10] This study aims to quantify rural-urban differences in up-to-date cervical cancer screening in CHCs before and during the pandemic and identify major contributing factors to these differences.…”