Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas.
Am J Prev Med. 2022 Dec;63(6):1026-1030. doi: 10.1016/j.amepre.2022.07.004. Epub 2022 Aug 8.
Fewer cancer diagnoses have been made during the COVID-19 pandemic. Pandemic-related delays in cancer diagnosis could occur from limited access to care or patient evaluation delays (e.g., delayed testing after abnormal results). Follow-up of abnormal test results warranting evaluation for cancer was examined before and during the pandemic.
Electronic trigger algorithms were applied to the Department of Veterans Affairs electronic health record data to assess follow-up of abnormal test results before (March 10, 2019-March 7, 2020) and during (March 8, 2020-March 6, 2021) the pandemic.
Electronic triggers were applied to 8,021,406 veterans' electronic health records to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder (urinalysis with high-grade hematuria), breast (abnormal mammograms), colorectal (positive fecal occult blood tests/fecal immunochemical tests or results consistent with iron deficiency anemia), liver (elevated alpha-fetoprotein), and lung (chest imaging suggestive of malignancy) cancers. Between prepandemic and pandemic periods, test quantities decreased by 12.6%-27.8%, and proportions of abnormal results lacking follow-up decreased for urinalyses (-0.8%), increased for fecal occult blood tests/fecal immunochemical test (+2.3%) and chest imaging (+1.8%), and remained constant for others. Follow-up times decreased for most tests; however, control charts suggested increased delays at 2 stages: early (pandemic beginning) for urinalyses, mammograms, fecal occult blood tests/fecal immunochemical test, iron deficiency anemia, and chest imaging and late (30-45 weeks into pandemic) for mammograms, fecal occult blood tests/fecal immunochemical test, and iron deficiency anemia.
Although early pandemic delays in follow-up may have led to reduced cancer rates, the significant decrease in tests performed is likely a large driver of these reductions. Future emergency preparedness efforts should bolster essential follow-up and testing procedures to facilitate timely cancer diagnosis.
在 COVID-19 大流行期间，癌症诊断数量有所减少。与癌症诊断相关的大流行相关延迟可能是由于获得医疗护理的机会有限或患者评估延迟（例如，异常结果后的延迟测试）所致。在大流行之前和期间，对需要评估癌症的异常检测结果的随访情况进行了检查。
应用电子触发算法对退伍军人事务部电子健康记录数据进行评估，以评估大流行前后（2019 年 3 月 10 日至 2020 年 3 月 7 日和 2020 年 3 月 8 日至 2021 年 3 月 6 日）异常检测结果的随访延迟。
应用电子触发算法对 8,021,406 名退伍军人的电子健康记录进行了分析，以确定需要评估 5 种癌症的异常结果的随访延迟：膀胱癌（尿高倍镜检查伴血尿），乳腺癌（异常乳房 X 线检查），结直肠癌（阳性粪便潜血试验/粪便免疫化学试验或符合缺铁性贫血的结果），肝癌（甲胎蛋白升高）和肺癌（胸部影像学提示恶性肿瘤）。在大流行前后期间，检测量减少了 12.6％-27.8％，并且缺乏随访的异常结果比例有所下降，尿液分析（-0.8％），粪便潜血试验/粪便免疫化学试验增加（+2.3％）和胸部成像（+1.8％），而其他测试结果保持不变。大多数测试的随访时间都缩短了；但是，控制图表明两个阶段的延迟增加：早期（大流行开始时）尿液分析，乳房 X 线检查，粪便潜血试验/粪便免疫化学试验，缺铁性贫血和胸部成像，以及晚期（大流行开始后 30-45 周）乳房 X 线检查，粪便潜血试验/粪便免疫化学试验和缺铁性贫血。
尽管大流行初期的随访延迟可能导致癌症发病率下降，但进行的检测数量大幅减少可能是导致这些下降的主要原因。未来的应急准备工作应加强基本的随访和检测程序，以促进及时的癌症诊断。
