Assessing the long-term impacts of the COVID-19 pandemic on disparities in cancer screening and follow-up

项目概要/摘要：COVID-19大流行导致癌症大幅减少 筛查和后续服务。在大流行的最初几个月，国家组织 建议推迟所有常规癌症筛查，导致成人初级保健的急剧减少 目前的比率仍远低于大流行前的水平。模型表明，这些 减少将导致超过57，000名癌症诊断遗漏和10，000名额外死亡 十年然而，这些模型在很大程度上是由主要由投保人组成的数据源提供信息的。 患者和缺乏种族/民族信息。因此，需要更多的信息来了解 需要战略和资源，以支持恢复卫生系统和社区， 受COVID-19影响最大。大流行对癌症筛查的影响可能特别 这对资源有限的联邦合格卫生中心（FMEHC）提供服务的患者来说意义深远， 为收入低于联邦贫困线的拉丁裔患者提供服务。Latinx 美国的癌症筛查率和随访率已经是最低的。 美国和美国可能会经历最大的护理减少和较慢的恢复正常以下 2019冠状病毒病。这部分是因为他们的社区受到COVID-19的打击特别严重（例如， 新冠肺炎感染率、住院率和失业率都很高），他们可能会害怕回国， 即使医疗当局认为它是安全的。我们提出的混合方法研究将 估计COVID-19大流行对患者癌症筛查率和随访率的影响 由一个大型的、多样化的社区卫生服务中心提供服务（目标1），并估计对癌症结果的影响（例如生活中的变化 年增加，癌症预防，晚期癌症发病率）， CRC-SPN癌症干预和监测建模网络（Aim 2）开发的模型。最后， 我们将从诊所工作人员和病人那里收集定性数据，以确定在大流行后改善的机会 为接受癌症预防中心服务的成年人提供癌症预防护理（目标3）。我们迫切需要了解 COVID-19护理减少对弱势群体的长期影响，并确定机会， 满足由癌症预防中心服务的患者的持续癌症预防需求。我们将与国家合作 利益攸关方制定具体的指导方针，为今后的干预措施提供信息， 因此，我们的研究结果将支持获得护理和减少健康差距 为受COVID-19影响最严重的社区提供服务。

PROJECT SUMMARY/ABSTRACT: The COVID-19 pandemic has led to dramatic reductions in cancer screening and follow-up services. During the early months of the pandemic, national organizations recommended postponing all routine cancer screening, resulting in dramatic reductions in adult primary care and specialty care visits; current rates remain far below pre-pandemic levels. Modeling suggests that these reductions will result in over 57,000 missed cancer diagnoses and 10,000 excess deaths over the next decade. However, these models are largely informed by data sources made up predominantly of insured patients and lacking race/ethnicity information. Thus, more information is needed to understand the strategies and resources need to support the recovery of health systems and communities that have been most impacted by COVID-19. The effects of the pandemic on cancer screening uptake may be particularly profound for patients served by resource-limited federally qualified health centers (FQHCs), which deliver services a large share of patients with incomes below the federal poverty level and who are Latinx. Latinx populations already have some of the lowest rates of cancer screening and follow-up care in the United States and are likely to experience the largest reductions in care and slower return to normal following COVID-19. This is, in part, because their communities have been hit particularly hard by COVID-19 (e.g. high rates of COVID-19 infections and hospitalizations and job loss) and they may fear returning for preventive care even when medical authorities have deemed it safe. Our proposed mixed-methods study will estimate the impact of the COVID-19 pandemic on rates of cancer screening and follow-up in patients served by a large, diverse FQHC (Aim 1), and estimate impacts on cancer outcomes (e.g. changes in life years gained, cancers prevented, and late-stage cancer incidence) in the FQHC population building on models developed by the CRC-SPN Cancer Intervention and Surveillance Modeling Network (Aim 2). Finally, we will gather qualitative data from clinic staff and patients to identify opportunities to improve post-pandemic cancer preventive care delivery for adults served by FQHCs (Aim 3). There is a critical need to understand the long-term impacts of COVID-19-care reductions on vulnerable populations and identify opportunities to meet the ongoing cancer prevention needs of patients served by FQHCs. We will collaborate with national stakeholders to develop FQHC-specific guidance to inform future interventions to support recovery from COVID-like care disruptions Thus, our findings will support access to care and reduction of health disparities for communities most impacted by COVID-19.