More than 600,000 people in the United States died from cancer in 2020 according to the American Cancer Society. The National Cancer Institute (NCI) reported that an additional 10,000 deaths will occur in the next date due to pandemic-related delays in screening and treatment in patients diagnosed with breast and colorectal cancers. Given this we can ascertain that the actual number of COVID-related deaths may be even higher.
Cancer is certainly not going to slow down or stop – even for a pandemic and still poses a major threat to population health. Resuming cancer screening as soon as possible will lead to better treatment outcomes by detecting and treating cancers in their earliest stage. Also, delays in cancer screening may lead to an already increasing trend in missed early-stage cancers that present with advanced stage of disease and result in poorer clinical outcomes.
At the beginning of the pandemic, delays in cancer directed treatment were appropriate and necessary. But in recent weeks the balance has begun to shift with emerging vaccines being distributed around the world and knowledge gained on how to prevent and treat COVID-19. Healthcare organizations and cancer centers have proactively implemented multiple measures to protect patients and staff from COVID-19 transmission. Today infection rates within cancer centers are uncommon. In a recent press release, the American College of Surgeons teamed up with the National Comprehensive Cancer Network (NCCN) and American Cancer Society (ACS) and other organizations to endorse resuming cancer screening in the United States. Cancer centers should review their safety protocols and be prepared to deal with the issues surrounding the epidemic while resuming screening events and delivery of timely care.
Considering the pandemic and social distancing requirements, it is time for the cancer program to be creative. While the Commission on Cancer (CoC) has given accredited facilities some leeway to meeting Standard 8.3 screening requirements in 2020-2021, they have also encouraged programs to explore other opportunities for conducting at least one event each calendar year. Screening events should be focused on increasing cancer awareness for a specific population relative to the facility’s region or community, such as those who are underinsured, minorities, or at-risk populations. Typically, screening is a single, one-day event where all clinical visits take place on the same day. After the event patients with abnormal results or a positive screen are to be followed and referrals or recommendations to an appropriate provider for further evaluation made. If a planned screening event was impacted by the pandemic the restrictions and steps taken to plan and conduct the event should be carefully documented, reviewed by the Cancer Committee and plan of action noted in the meeting minutes.
Creative planning of screening events could include exploring partnerships or community-based venues. Partnering with interdepartmental or community-based resources or moving the event out into the communities themselves via mobile clinics, screening vans or community health clinics. A virtual cancer prevention event paired with a no-contact screening and testing offer for fecal occult blood testing or Cologuard for colon cancer is another option. Of course, as pandemic-related restrictions are lifted throughout the year the facility can resume holding events in their usual fashion.
To encourage patient and community participation in cancer screening, healthcare organizations will want to address the public safety concerns which includes:
- Routine screening is still important. The earlier it is detected the less invasive the treatment will be and the better outcome and quality of life after treatment. Patients considered to be high-risk should be encouraged to continue their regular screening schedule and not postpone or delay their tests or visits with their doctor.
- Communities and safety protocols are unique. Depending on the severity of the pandemic in each area, policies may differ. Healthcare facilities business hours may be reduced or the number of patients entering a facility or department within the facility may be limited. Patients should ask about this process before presenting for their appointment and be provided with information on the safety procedures and what is expected of them prior to their scheduled visit.
- Testing options and alternatives. Many screening exams, such as colonoscopy, Pap smear, PSA, low dose lung and screening mammography require an in-person visit. But cancer programs may offer other no-contact options for some screenings, such as fecal occult blood testing or stool DNA testing (i.e., Cologuard) for colon cancer. Telemedicine is widely being used for many types of medical visits including skin cancer screening. These alternatives may be equally as effective in identifying an underlying cancer or medical condition and opens the lines of communication between the provider and the patient should further evaluation be needed.
In summary, cancer programs should explore opportunities for resuming cancer screening as soon as possible to continue the national trends in decreasing overall cancer incidence. Cancer screening is an effective way to detect cancer in its earliest stage. Early detection saves lives and improves clinical and quality outcomes. Despite the pandemic cancer programs can, and should, resume cancer screening activities as soon as possible.
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