'Under Pressure': Access to Cancer Care in Chile During the COVID-19 Pandemic

Abstract

Background: A decreased health services utilization due to the COVID pandemic is a global concern, potentially deepening health inequalities, particularly for time-sensitive conditions such as cancer, a leading cause of death. Disruptions in its diagnosis and treatment impose severe long-term consequences. We examine the impact of the SARS-COV-2 pandemic on access to cancer care in the context of a highly unequal latin-american health system like Chile. We analyze differential effects by insurance-type, proxy of socioeconomic status, gender and age.Methods: Quasi-experimental study using interrupted time series analysis (ITSA). We obtained information from multiple sources for a wide evaluation of cancer-related healthcare utilization in Chile two to three years prior to the pandemic until December-2020. We fitted negative binomial ITSA models adjusted by population groups for a range of health services and cancer diagnoses.Results: We observed a sharp reduction in oncological healthcare utilization in March. This is followed by a slow, yet incomplete, recovery over 2020. There was a one-third accumulated reduction of cancer-related services, diagnostic confirmations and sick-leaves in 2020. The reduction was more pronounced on women and the publicly-insured population. We estimate 5,132 persons with four common cancers missed an early diagnosis.Interpretation: The pandemic stressed the Chilean healthcare system, reducing access to essential cancer services with a sizable and wide impact on cancer care. Service utilization reduction preceded the implementation of large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting increasing gender and socio-economic inequalities.Funding: This work was funded by the National Research & Development Agency of Chile - ANID (Project ANID-COVID 0960). JP’s and SFA’s PhD studies are supported by ANID (CONICYT-PFCHA/Doctorado Nacional/2020-21200241 and CONICYT-PFCHA/Doctorado Nacional/2020-21200398).Conflict of Interest: The authors have no conflicts of interest to declare.