Modelling the impacts of COVID-19 pandemic on the quality of population-based colorectal cancer screening.
Modelling the impacts of COVID-19 pandemic on the quality of population-based colorectal cancer screening.
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DOI：
10.1016/j.ypmed.2021.106597
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发表时间：
2021-10
影响因子：
5.1
通讯作者：
Chen TH
中科院分区：
文献类型：
--
作者：
Jen GH;Yen AM;Hsu CY;Chiu HM;Chen SL;Chen TH
新冠肺炎大流行严重影响了常规公共卫生干预措施，包括基于人群的癌症筛查。这种筛选延迟对结构和筛选过程的变化以及由此产生的长期结果的影响尚不清楚。因此，有必要制定一个系统的框架来评估与这些质量组成部分有关的这些影响。以基于人群的癌症筛查和粪便免疫化学检测(FIT)为例，主要分析评估各种筛查延迟情景如何与初次筛查能力和结肠镜检查的全时当量(FTE)相关，并基于人群水平的马尔可夫决策树模型影响长期结果。第二个分析是量化以社会距离指数衡量的新冠肺炎疫情程度如何影响运力和FTE，这两个指标转化为指数关系的延误。与两年一次的常规FIT筛查相比，新冠肺炎的流行导致延迟0.5年、1年、1.5年和2年的晚期癌症风险分别增加了25%、29%、34%和39%。四个延迟的结直肠癌死亡时间表(CRC)的相应统计结果分别为26%、28%、29%和30%。较高的社会距离指数导致较低的摄取筛查能力和较大的FTE减少，导致较长的筛查延迟和较长的等待时间，从而进一步影响如上所述的长期结果。综上所述，本研究以台湾人口为基础的结直肠癌适合性筛查为例，建立系统的模拟方法，以显示新冠肺炎疫情所造成的筛查延迟对长期结果的强烈影响。
COVID-19 pandemic has severely affected regular public health interventions including population-based cancer screening. Impacts of such screening delays on the changes in structure and screening process and the resultant long-term outcomes are unknown. It is therefore necessary to develop a systematic framework to assess theses impacts related to these components of quality. Using population-based cancer screening with fecal immunochemical test (FIT) as an illustration, the main analysis was to assess how various scenarios of screening delays were associated with the capacity for primary screening and full time equivalent (FTE) for colonoscopy and impact long-term outcomes based on a Markov decision tree model on population level. The second analysis was to quantify how the extent of COVID-19 epidemic measured by social distancing index affected capacity and FTE that were translated to delays with an exponential relationship. COVID-19 epidemic led to 25%, 29%, 34%, and 39% statistically significantly incremental risks of late cancer for the delays of 0.5-year, 1-year,1.5-year, and 2-year, respectively compared with regular biennial FIT screening. The corresponding statistically findings of four delayed schedules for death from colorectal cancer (CRC) were 26%, 28%, 29%, and 30%, respectively. The higher social distancing index led to a lower capacity of uptake screening and a larger reduction of FTE, resulting in longer screening delay and longer waiting time, which further impacted long-term outcomes as above. In summary, a systematic modelling approach was developed for demonstrating the strong impact of screening delays caused by COVID-19 epidemic on long-term outcomes illustrated with a Taiwan population-based FIT screening of CRC.
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