Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.
Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
Cancer. 2022 Oct;128(20):3727-3733. doi: 10.1002/cncr.34386. Epub 2022 Aug 22.
Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown.
Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years).
Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years.
Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted.
癌症幸存者是一类医疗需求较高的人群。目前尚不清楚癌症幸存者在 2019 年冠状病毒病（COVID-19）大流行的第一年受到了怎样的影响，以及受到了怎样的影响。
作者利用全美基于人群的行为危险因素监测系统（2017-2020 年）的数据，调查了 COVID-19 大流行期间癌症幸存者健康相关指标的变化情况，并将其与美国无癌症病史成年人的变化进行了比较。保险覆盖、就业状况、健康行为和健康状况等社会人口学和健康相关指标均为自我报告。采用多变量逻辑回归计算了 2020 年与 2017-2019 年相比健康相关指标的调整后患病率比值，并按年龄组（18-64 岁与≥65 岁）进行了分层。
在 18-64 岁的成年人中，尽管失业率上升，但 2020 年的未参保率并未显著增加。无论是否有癌症病史，不健康行为（如睡眠不足和吸烟）的流行率在 2020 年均有所下降，自我报告的健康状况有所改善。值得注意的是，与非老年无癌症病史成年人相比，癌症幸存者的吸烟率下降幅度更大。≥65 岁的成年人中观察到的变化很少。
需要进一步研究来证实观察到的积极健康行为和健康变化，并调查潜在机制的作用，例如国家和区域针对大流行的政策应对措施对保险覆盖、失业救济金和财政援助的影响。随着与公共卫生紧急事件相关的政策到期，有必要对大流行对癌症生存者的长期影响进行持续监测。
