Advertisement

Impact of COVID-19 on colorectal cancer disparities and the way forward

      In response to the coronavirus disease 2019 (COVID-19) pandemic, the U.S. Surgeon General advised all hospitals and ambulatory care centers to delay nonurgent medical procedures and surgeries. This recommendation, echoed by a multigastroenterology society guideline, led to the suspension of colonoscopies for colorectal cancer (CRC) screening and surveillance. Although this temporary suspension was necessary to contain COVID-19 infections, we as gastroenterologists, patient advocates, and CRC researchers have witnessed the downstream impact of COVID-19 and this recommendation on CRC screening, research, and advocacy. These effects are particularly noticeable in medically underserved communities where CRC morbidity and mortality are highest. COVID-19–related pauses in medical care, as well as shifts in resource allocation and workforce deployment, threaten decades worth of work to improve CRC disparities in medically underserved populations. In this perspective, we present the unique challenges COVID-19 poses to health equity in CRC prevention and provide potential solutions as we navigate these uncharted waters.

      Graphical abstract

      Abbreviations:

      CBPR (community-based participatory research), CRC (colorectal cancer), FIT (fecal immunochemical test), FOBT (fecal occult blood test), FQHC (federally qualified health centers)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Worldometer
        COVID-19 coronavirus pandemic.
        (Available at:)
        • Choo E.K.
        COVID-19 fault lines.
        Lancet. 2020; 395: 1333
      1. Bibbins-Domingo K. This time must be different: disparities during the COVID-19 pandemic. Ann Intern Med. Epub 2020 Apr 28.

        • Siegel R.L.
        • Miller K.D.
        • Fedewa S.A.
        • et al.
        Colorectal cancer statistics, 2017.
        CA Cancer J Clin. 2017; 67: 177-193
        • Carethers J.M.
        • Doubeni C.A.
        Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies.
        Gastroenterology. 2020; 158: 354-367
        • de Klerk C.M.
        • Gupta S.
        • Dekker E.
        • et al.
        Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide.
        Gut. 2018; 67: 679-687
        • Liss D.T.
        • Baker D.W.
        Understanding current racial/ethnic disparities in colorectal cancer screening in the United States: the contribution of socioeconomic status and access to care.
        Am J Prev Med. 2014; 46: 228-236
        • American Cancer Society
        Colorectal cancer facts & figures 2020-2022.
        American Cancer Society, Atlanta, GA2020
      2. Mehrotra A, Chernew M, Linetsky D, et al. What impact has COVID-19 had on outpatient visits? To the Point (blog), Commonwealth Fund, April, 23, 2020. Available at: https://doi.org/10.26099/ds9e-jm36.

        • EPIC Health Research Network
        Preventive cancer screenings during COVID-19 pandemic.
        (Available at:)
        • Robertson D.J.
        • Lee J.K.
        • Boland C.R.
        • et al.
        Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer.
        Am J Gastroenterol. 2017; 112: 37-53
        • Singal A.G.
        • Gupta S.
        • Tiro J.A.
        • et al.
        Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: a randomized controlled trial in a safety-net health system.
        Cancer. 2016; 122: 456-463
        • Selby K.
        • Baumgartner C.
        • Levin T.R.
        • et al.
        Interventions to improve follow-up of positive results on fecal blood tests: a systematic review.
        Ann Intern Med. 2017; 167: 565-575
        • Coronado G.D.
        • Petrik A.F.
        • Vollmer W.M.
        • et al.
        Effectiveness of a mailed colorectal cancer screening outreach program in community health clinics: the STOP CRC Cluster randomized clinical trial.
        JAMA Intern Med. 2018; 178: 1174-1181
        • Bibbins-Domingo K.
        • Grossman D.C.
        • Curry S.J.
        • et al.
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2016; 315 (Accessed April 27, 2020): 2564-2575
        • Corley D.A.
        • Jensen C.D.
        • Quinn V.P.
        • et al.
        association between time to colonoscopy after a positive fecal test result and risk of colorectal cancer and cancer stage at diagnosis.
        JAMA. 2017; 317: 1631-1641
        • Martin J.
        • Halm E.A.
        • Tiro J.A.
        • et al.
        Reasons for lack of diagnostic colonoscopy after positive result on fecal immunochemical test in a safety-net health system.
        Am J Med. 2017; 130: 93
        • Sarfaty M.
        • Doroshenk M.
        • Hotz J.
        • et al.
        Strategies for expanding colorectal cancer screening at community health centers.
        CA Cancer J Clin. 2013; 63: 221-231
        • Oluloro A.
        • Petrik A.F.
        • Turner A.
        • et al.
        Timeliness of colonoscopy after abnormal fecal test results in a safety net practice.
        J Commun Health. 2016; 41: 864-870
        • Issaka R.B.
        • Singh M.H.
        • Oshima S.M.
        • et al.
        Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system.
        Am J Gastroenterol. 2017; 112: 375-382
        • Thamarasseril S.
        • Bhuket T.
        • Chan C.
        • et al.
        The need for an integrated patient navigation pathway to improve access to colonoscopy after positive fecal immunochemical testing: a safety-net hospital experience.
        J Commun Health. 2017; 42: 551-557
        • McCarthy A.M.
        • Kim J.J.
        • Beaber E.F.
        • et al.
        Follow-up of abnormal breast and colorectal cancer screening by race/ethnicity.
        Am J Prev Med. 2016; 51: 507-512
        • May F.P.
        • Almario C.V.
        • Ponce N.
        • et al.
        Racial minorities are more likely than whites to report lack of provider recommendation for colon cancer screening.
        Am J Gastroenterol. 2015; 110: 1388-1394
        • Yabroff K.R.
        • Gansler T.
        • Wender R.C.
        • et al.
        Minimizing the burden of cancer in the United States: Goals for a high-performing health care system.
        CA Cancer J Clin. 2019; 69: 166-183
        • Salz T.
        • Weinberger M.
        • Ayanian J.Z.
        • et al.
        Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.
        BMC Health Serv Res. 2010; 10: 256
        • Neugut A.I.
        • Zhong X.
        • Lebwohl B.
        • et al.
        Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study.
        Therap Adv Gastroenterol. Epub. 2018 Mar 26;
        • Pasick R.
        • Oliva G.
        • Goldstein E.
        • et al.
        Community-engaged research with community-based organizations: a resource manual for UCSF researchers.
        in: Fleisher P. UCSF Clinical and Translational Science Institute (CTSI) resource manuals and guides to community-engaged research. University of California San Francisco, San Francisco, CA2010 (p. 1-27)
        • United States Department of Labor, Washington DC, USA. U.S. Bureau of Labor Statistics
        Labor force statistics from the current population survey. 2010 (Available at: https://www.bls.gov/cps/. Accessed July 2, 2020)
        • Honein-AbouHaidar G.N.
        • Kastner M.
        • Vuong V.
        • et al.
        Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening.
        Cancer Epidemiol Biomarkers Prev. 2016; 25: 907-917
        • Centers for Disease Control and Prevention
        COVID-19 in racial and ethnic minority groups.
        (Available at:)
        • He J.
        • Efron J.E.
        Screening for colorectal cancer.
        Adv Surg. 2011; 45: 31-44
        • Cram P.
        • Fendrick A.M.
        • Inadomi J.
        • et al.
        The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect.
        Arch Intern Med. 2003; 163: 1601-1605
        • Balzora S.
        • Gray D.
        Everyone needs to see this: Will Smith gets a colonoscopy. Healio Gastroenterology.
        (Available at:)
        • Centers for Disease Control and Prevention
        Cases of coronavirus disease (COVID-19) in the U.S.
        (Available at:)
        • Colorectal Cancer Alliance
        Screening and financial assistance.
        (Available at:)