Quality Improvement Strategies in Cancer Screenings Interrupted by COVID-19 in Primary Care

Abstract

COVID-19 caused a quarantine that closed many primary care offices where patients were unable to receive their routine cancer screenings. The delayed cancer screenings lead to increased morbidity and mortality. A literature review of Breast, Cervical, and Colorectal (BCC) cancer screening compared to 2019 indicates that screenings have not returned to pre-pandemic levels. Several strategies were adopted to counteract this disruption including active outreach to at-risk patients, expanding the use of telehealth appointments, and offering home stool assay kits conducted at the patient’s convenience. We looked at whether strategies were effective in a primary care office in NJ. We found that COVID-19 has increased the popularity of using stool-based home kits and made up the majority of CRC screenings, although overall screenings have remained below pre-pandemic levels. Cervical cancer screenings remain at low rates and may benefit from other routes of testing. Home HPV kits could be beneficial in diminishing the deficit and has already seen promising data in prior studies. Breast cancer screenings do not have a home-testing equivalent, however the popularity of telehealth appointments offers the opportunity to reiterate the importance of routine screenings. Telehealth has been shown to be beneficial in getting patients to complete their wellness visits and routine BCC cancer screenings as shown by the increase of wellness visits in the summer of 2020. Despite ongoing efforts, routine BCC cancer screenings remain 5% below what they were compared to 2019 and these strategies must continue beyond COVID-19 to address the BCC cancer screening deficit.