Healthcare use among cancer survivors during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic and the restrictive measures applied to prevent and control this disease have led to a substantial shift in healthcare systems, with a redefinition of priorities and essential care, causing a serious impact in the oncological care. Therefore, we aimed to estimate the association of a previous cancer diagnosis on healthcare use during the COVID-19 pandemic among European and Israelis cancer survivors (CS). Methods This cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. All CS (n = 6,490) were country-, sex-, age- and education-matched (1:2) to non-cancer individuals (NC). Odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression. Results Overall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI:1.19-1.41), than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI:1.39-2.30). Likewise, CS reported the occurrence of postponements more often (OR = 1.54, 95%CI:1.44-1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI:1.63-2.36), who reported higher economic difficulties (OR = 1.73, 95%CI:1.50-2.00) and those with no multimorbidity (OR = 1.85, 95%CI:1.62-2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI:1.26-1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI:1.47-5.01). Conclusions CS were more likely to forgo medical treatment and to report healthcare postponements and to be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum. Key messages • During the COVID-19 pandemic, a previous cancer diagnosis was associated with a more frequent report of appointment cancellations, postponements or denials. • The first months of the COVID-19 pandemic led to changes in healthcare provided to cancer survivors, which may have a deleterious impact in their care and prognosis.


Background:
According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder. Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the most disabling MSK disorders. According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes. Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018.

Methods:
Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019. Mortality data was retrieved from the Belgian statistical office for people dying from RHE. Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths.

Results:
The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018). The burden was higher in women and the gender disparities increased with age. Women died also more frequently due to RHE compared to men. In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY).

Conclusions:
The burden of MSK disorders has increased over the years. In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY. Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions. Key messages: MSK disorders represent a major health problem in Belgium.
Acting on risk factors associated to these disorders is crucial to mitigate their burden.

Background:
The COVID-19 pandemic and the restrictive measures applied to prevent and control this disease have led to a substantial shift in healthcare systems, with a redefinition of priorities and essential care, causing a serious impact in the oncological care. Therefore, we aimed to estimate the association of a previous cancer diagnosis on healthcare use during the COVID-19 pandemic among European and Israelis cancer survivors (CS).

Methods:
This cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. All CS (n = 6,490) were country-, sex-, age-and education-matched (1:2) to noncancer individuals (NC). Odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.

Conclusions:
CS were more likely to forgo medical treatment and to report healthcare postponements and to be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Key messages:
During the COVID-19 pandemic, a previous cancer diagnosis was associated with a more frequent report of appointment cancellations, postponements or denials. The first months of the COVID-19 pandemic led to changes in healthcare provided to cancer survivors, which may have a deleterious impact in their care and prognosis.