During the early days and the height of the COVID-19 pandemic, many hospitals across the country were limiting elective procedures and tests that fell in the category of cancer screenings, and patients themselves were cancelling primary care appointments out of fear of COVID.
"That has caused a crisis that has not been talked about enough," said Chris Barnes, executive director of Alabama Oncology. "The pandemic has potentially created a situation where many cancers are going to be diagnosed in a later stage. It's a problem that's not immediately known in terms of quantifiable data - it's anecdotal at this point - but it could become known over the next couple of years. I think that problem is amplified in communities with people of color, where there's already a disparity of access and consumption of healthcare services, so it could be an even bigger problem in those communities."
RealTime Medicare Data, Ltd. has produced visualizations that show the number of procedures for three types of cancer screenings (colonoscopies, mammography, and prostate-specific antigens, or PSAs) for Alabama Medicare beneficiaries, based on Medicare CMS 1500 Fee-for-Service claims data from Jan. 2020 - April 2021. It does not include Medicare Advantage claims. The visualizations show the drop in screenings during the early part of the pandemic.
Because Alabama Oncology patients have been diagnosed with cancer before they come to the practice, they don't have a specific program to encourage patients to get appropriate screenings now, but they are supporting the effort to promote screenings out of concern for the potential consequences.
"With delayed cancer diagnoses, outcomes are potentially different," Barnes said. "Cancer is more expensive to treat in later stages; there is more potential of comorbidities and side effects; higher consumption of ER and hospital services. In little ways, we are trying to support messaging around bringing attention to this issue and making it visible in the community and encouraging people to get screened. As we have conversations with our peers - surgeons and primary care doctors - we share this message so they can advocate with their patients."
Urology Centers of Alabama conducts cancer screenings, and they, too, are working to bring attention to this issue. "While we did see a decrease in prostate cancer screenings in 2020, during the second half of 2021, we have seen our screening numbers begin to normalize," CEO Jason Biddy said. "Urology Centers of Alabama continues to partner with the Urology Health Foundation and the Mike Slive Foundation. By offering free PSA screenings in rural areas and providing education, we are bringing awareness of the importance of prostate cancer screenings. Of course, September is Prostate Awareness month and we utilized our social media platform to create awareness throughout the community."
The Community Oncology Alliance (COA) has launched a national effort to get cancer screenings back to more "normal" levels. Their website at communityoncology.org offers a free download of their Practice Toolkit, which says, in part:
"COA Members are urged to share these tools among their professional networks of other clinicians they work with so they too can share resources directly with patients.
"These resources are all about Time to Screen, a collaborative effort from CancerCare and COA that helps people take control of their health. The toll-free hotline (1-855-53-SCREEN) and TimetoScreen.org website direct visitors to information and help in finding local screening locations.
"Sharing this toolkit empowers you to engage your patients through resources and materials aimed to support overall health and well-being."
"It really comes down to awareness and messaging," Barnes said. The medical community is being encouraged to bring that awareness to their patients in a systematic and consistent fashion.