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The Impact of COVID-19 on Routine Medical Care and Cancer Screening
Neil S Wenger1, Annette L Stanton2, Ryan Baxter-King3
1Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA. nwenger@mednet.ucla.edu.
Insights
Fear and COVID-19 restrictions led to significant medical care cancellations. Adults with medical conditions, anxiety, and depression were more likely to postpone or cancel appointments, highlighting a need for targeted support.
Area of Science:
- Public Health
- Health Services Research
- Mental Health
Background:
- COVID-19 restrictions and fear significantly altered healthcare utilization patterns.
- Understanding the scope of cancelled/postponed medical appointments is crucial for addressing unmet healthcare needs.
Purpose of the Study:
- To quantify the proportion of medical visits and cancer screenings that were cancelled or postponed.
- To identify demographic, clinical, and psychological factors associated with these cancellations/postponements.
Main Methods:
- Nationally representative cross-sectional online surveys conducted in May, July, October, and December 2020.
- Involved 59,747 US adults, assessing cancelled/postponed physical and mental health visits and cancer screenings.
- Analyzed relationships with demographics, medical conditions, local COVID-19 death rates, anxiety, depressive symptoms, coping, and perceived risk.
Main Results:
- In May 2020, 64% of those with medical appointments had them cancelled/postponed, decreasing to 37% by December.
- 20% of scheduled cancer screenings were cancelled/postponed, remaining stable throughout the study period.
- Medical conditions, anxiety, and depressive symptoms were strongly associated with higher rates of cancellations/postponements, with associations growing over time.
Conclusions:
- Cancelled medical care and cancer screenings were prevalent, particularly among individuals with pre-existing conditions and mental health challenges.
- These cancellations persisted even when controlling for local COVID-19 mortality rates.
- Interventions are needed to support patients avoiding necessary care due to anxiety, depression, or misperceptions of risk.
Background:
COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need.
Objective:
To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements.
Design:
Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020.
Participants:
59,747 US adults who completed 15-min online surveys. 69% cooperation rate.
Measures:
Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk.
Key Results:
Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December.
Conclusions:
Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.
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