Abstract
BackgroundCOVID-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.ObjectiveTo 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.DesignFour nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020.Participants59,747 US adults who completed 15-min online surveys. 69% cooperation rate.MeasuresPhysical 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 ResultsOf 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.ConclusionsCancelled 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.
Highlights
COVID-19 has upended myriad aspects of life, receipt of usual medical care
Many health care providers cancelled elective procedures and visits[1] and medical visits were frequently avoided.[2]. These actions were logical because medical facilities are where COVID-19infected patients are diagnosed and treated, medical interactions often violate social distancing, and people needing medical care often are at risk for adverse outcomes from COVID19
58% (N = 34,868) of the respondents had a medical appointment during the 2 months prior to survey, and this increased slightly from May through December
Summary
COVID-19 has upended myriad aspects of life, receipt of usual medical care. Increased levels of non-COVID-19 death have been reported during these periods of medical care avoidance.[9] Early data suggest fewer early cancer diagnoses[10] and portend worse outcomes.[11,12] Further, missed appointments and treatments among patients with existent cancer are expected to result in increased cancer mortality.[13]. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID19 risk. 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 Received March 1, 2021 Accepted October 28, 2021 anxiety, depression and inaccurate perceptions of risk will be important
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