Avoidance Of Medical Care Research Articles

Foregone care in the Italian elderly population: a new challenge for the National Health System

Abstract Background The avoidance of medical care among the elderly in Italy has been exacerbated during the COVID-19 pandemic and today, according to data from the Passi d’Argento surveillance, it involves over 3 million elders. The study analyzes the medical care avoidance among the elderly in Italy, the motivations behind it and the changes over time. Methods Passi d’Argento surveillance system, coordinated by the Italian National Institute of Health and conducted by Local Health Units, continuously collects information on health and lifestyles, as well as care and assistance needs, of the population aged over 65 residing in Italy, through interviews with representative samples by gender and age. Results Between 2021 and 2022, 1 in 4 individuals over the age of 65 (24%) reported avoiding, in the 12 months before the interview, a medical visit or diagnostic test they needed. The phenomenon is higher among those reporting significant economic difficulties (37%). Among those who have waived, 31% said they did so for fear of Sarsv-Cov-2 infection; 22% due to suspension of service and/or closure of the practice because of the restrictions imposed by the COVID-19 pandemic; 36% declared that the avoidance reason was due to long waiting lists; 7% due to difficulty reaching the facility. With the end of the pandemic, this phenomenon has decreased overall (from 34% in 2020 to 23% in 2022), however, there is an increase of individuals who report renouncing due to long waiting lists or difficulties accessing services. Conclusions Data clearly highlights the difficulties of National Health System in meeting the health needs of elderly citizens, which persist even after the pandemic. It is important to preserve the right and the access to prevention and care for the elderly, for which timeliness is crucial. In this perspective, these data can provide important guidance for action at both national and regional levels. Key messages • Having national data on foregone care allows to see the burden of the phenomenon. • Even after the pandemic, the phenomenon of medical care avoidance among the elderly continues to be observed.

Vision Problems As a Contributor to Lower Engagement in Care Among Aging Men Living with HIV

ABSTRACT Purpose To investigate vision impairment as a barrier to engagement in medical care among aging persons living with HIV (PLWH) who experience multimorbidity and complex care needs. Setting Multicenter AIDS Cohort Study (MACS), a prospective observational cohort of aging PLWH men. Methods We examined relationships of self-reported vision difficulty with indicators of care engagement: 1) adherence to HIV antiretroviral therapy (ART; defined as taking ≥95% of medications); 2) self-reported avoidance of medical care; 3) self-reported tendency to ask a doctor questions about care (>2 questions at a medical visit), as well as with quality of life. A modified version of the National Eye Institute Vision Function Questionnaire was administered at three semi-annual visits (from October 2017 to March 2019) to assess difficulty performing vision-dependent tasks. Results We included 1063 PLWH (median age 57 years, 31% Black). Data on care engagement outcomes were analyzed using repeated measures logistic regression with generalized estimating equations adjusted for race, and at visit values for age, education level, depressive symptoms, alcohol use, and smoking status. Compared to no vision difficulty, those reporting moderate to extreme vision difficulty on at least one task had 2.2 times higher odds (95% CI: 1.4, 3.4) of having less than optimal ART adherence, 1.9 times higher odds (95% CI: 1.1, 3.4) of avoiding necessary medical care and median quality of life scores 8 points lower. Conclusion These findings suggest vision impairment decreases medical care engagement including HIV care and quality of life among aging PLWH.

Experiences of Aging with Opioid Use Disorder and Comorbidity in Opioid Treatment Programs: A Qualitative Analysis

BackgroundThe number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined.ObjectiveTo explore the aging experience with OUD and barriers to medical care for older adults who receive care in OTPs.DesignFrom November 2021 to July 2022, we conducted 1-to-1, semi-structured qualitative interviews in English and Spanish, audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding the challenges of aging with OUD and managing chronic diseases.ParticipantsThirty-six adults aged ≥ 55 enrolled in OTPs in San Diego, California.ApproachA descriptive qualitative approach was used. Major themes and subthemes were identified through thematic analysis until thematic saturation was reached.Key ResultsAll participants were on methadone and had a mean age of 63.4 (SD 5.1) years; 11 (30.6%) identified as female, 14 (39%) as Hispanic/Latino, and 11 (36%) as Black, with a mean duration of methadone treatment of 5.6 years. Chronic diseases were common, with 21 (58.3%) reporting hypertension, 9 (25%) reporting untreated hepatitis C, and 32 (88.9%) having ≥ 2 chronic diseases. Three major themes emerged: (1) avoidance of medical care due to multiple intersectional stigmas, including those related to drug use, substance use disorder (SUD) treatment, ageism, and housing insecurity; (2) increasing isolation with aging and loss of family and peer groups; (3) the urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges.ConclusionsOlder adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.

Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care

BackgroundSexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population’s health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings.ObjectiveTo explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs.DesignSemi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018.ParticipantsThe study included a sample of 43 young adult SMM (ages 25–27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City.ApproachResearchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts.Key ResultsAnalyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants’ identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers.ConclusionsSMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients’ preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.

Factors associated with delay or avoidance of medical care during the COVID-19 pandemic in Armenia: results from a nationwide survey

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems throughout the world. Many patients faced delays and cancellation of care due to scaled back services, mobility restrictions, and concerns related to the risk of infection. The present study aimed to assess the prevalence of and risk factors associated with the avoidance or delay of medical care due to COVID-19 in Armenia.MethodsWe conducted a cross-sectional telephone survey of 3,483 adults across Armenia. We used stratified two-stage cluster sampling to select the participants from different age groups proportionate to their size in the population. Logistic regression analysis assessed the association of risk factors with avoidance/delay of routine, urgent/emergency, and any medical care.ResultsThe mean age of the sample was 49.5 (SD = 14.8), ranging from 18 to 90. About 9.9% of the respondents avoided/delayed any type of medical care; whereas 5.5% avoided/delayed urgent/emergency care and 6.6% routine care. In the adjusted analysis, female gender and higher monthly expenditures were associated with avoidance/delay of routine medical care. Factors associated with delay/avoidance of urgent/emergency care included female gender and higher perceived threat of COVID-19. Younger age, female gender, higher perceived threat and not being vaccinated against COVID-19 were associated with avoidance/delay of any medical care in the adjusted analysis.ConclusionSince avoiding or delaying care might increase morbidity and mortality associated with conditions not related to COVID-19, identifying population groups that are more likely to avoid care is important. Targeting such groups with educational interventions focusing on the risks of using versus not using medical care in times of pandemic might be crucial. Ensuring the provision of in-home healthcare services for high-risk groups might help to address important medical care needs during the pandemic.

Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities

BackgroundPeople with disabilities face heightened vulnerability to COVID-19. ObjectiveThis study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic. MethodsThis cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression. ResultsAmong 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care. ConclusionsDisability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.

Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic.

Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic. This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4. During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9). This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.

The Economic Burden of Heart Failure with Reduced Ejection Fraction: Living Longer but Poorer?

Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making.

Oral analgesic for musculoskeletal injuries in children: A systematic review and network meta-analysis.

Pain in pediatric musculoskeletal (MSK) injuries can lead to increased anxiety, fear, and avoidance of medical care, making analgesic management critical. Therefore, we evaluated analgesic efficacy and adverse effects to select the optimal analgesic agent in pediatric patients with MSK injuries. Four databases were searched from inception to March 2023 for peer-reviewed, open randomized controlled trials (RCTs). Inclusion criteria were: (1) trials with RCT design, (2) children aged 1 month-18 years with MSK injury, (3) outpatient setting, (4) interventions and control, (5) primary outcome of pain score at 60 and 120 min and secondary outcome of adverse effects, and (6) full-text and peer-reviewed articles. Two reviewers screened, extracted data, and assessed the risk of bias. A frequentist random-effects network meta-analysis (NMA) was performed. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation working group approach. We included eight trials comprising 1645 children. Ibuprofen was significantly associated with pain reduction at 120 min, compared with acetaminophen (SMD 0.31 [95% CI 0.11-0.51]; moderate certainty) and opioids (SMD 0.34 [95% CI 0.20-0.48]; moderate certainty). Compared with opioids alone, ibuprofen-opioid combination was significantly associated with pain reduction at 120 min (SMD 0.19 [95% CI 0.03-0.35]). No significant differences were found in pain interventions at 60 min. Ibuprofen had statistically fewer adverse events than opioids (RR, 0.54 [95% CI 0.33-0.90]; moderate certainty) and ibuprofen with opioids (RR 0.47 [95% CI 0.25-0.89]; moderate certainty). In terms of limitations, the eight RCTs included had relatively small sample sizes; only two were high-quality RCTs. Our NMA found ibuprofen to be the most effective and least adverse analgesic in pediatric patients with MSK injuries.

Health Insurance Literacy and Medical Care Avoidance Among International Students: A Case Study.

Objectives: This research examines the health insurance literacy and healthcare utilization of international students attending a university in the US Midwest. Methods: One hundred and forty-three undergraduate and graduate students attending a midsize metropolitan university in the Midwest completed an online survey in early 2022. Results: Many students surveyed could not identify the definitions of basic terms, such as copay. Furthermore, about 80% of students surveyed could not determine their financial responsibilities in two medical settings. Regression results show that the continent they are from and the length of their stay in the United States significantly predict their understanding of key health insurance terms. More than half of the international students surveyed indicated they often feel confused about their health insurance (57.34%). Only about 20% have delayed or skipped care due to unfamiliarity with the health insurance system. Conclusion: The health insurance literacy of most international students at the midwestern university we surveyed is not ideal. This and possibly other universities in the United States should take more initiatives to help their international students understand the health insurance system.

Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report.

People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs. This study aimed to analyze the process of a multidisciplinary team-encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs-that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges. Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.

Alienation from medical care policy, medical care avoidance, and the role of sex and risk perception

BackgroundMedical care avoidance affects individuals’ health status. Previous studies on medical care avoidance have mainly focused on medical costs and people’s satisfaction with medical services. This study investigates whether an individual’s sense of policy alienation toward medical care policy (SPA-M) affects behavioral intention of medical care avoidance, and to what extent an intermediary variable—medical financial risk perception–mediates the relationship between SPA-M and medical care avoidance.MethodsA cross-sectional survey was conducted involving 434 people aged 35–59 years from Wuhu, a city in China’s Anhui province. A moderated mediation model was constructed to investigate the research question and sex (biological: male and female) was used as a moderating variable between SPA-M and medical financial risk perception.ResultsWe found that SPA-M significantly impacted medical care avoidance, and that medical financial risk perception played a complete mediating role in this relationship, while sex moderated the relationship between SPA-M and medical financial risk perception.ConclusionThis study contributes to the literature by enhancing our understanding of the factors that influence behavioral intention regarding medical care avoidance, deepening our understanding of the role of SPA-M in medical care policy, and expanding the role of sex differences in the analysis of the relationship between SPA-M, medical financial risk perception, and medical care avoidance, offering implications for public and community health.

Difficulties in accessing health services and the avoidance of medical care during covid-19 pandemic: The experience on italian the elderly population

Difficulties in accessing health services and the avoidance of medical care during covid-19 pandemic: The experience on italian the elderly population

Does health literacy affect older people's avoidance of medical care? The sense of medical care policy alienation and perceptions of control

We aimed to clarify whether health literacy (HL) impacts medical care avoidance through an underexplored mediator: a sense of policy alienation towards medical care policy for residents (SPA-M). A moderated mediation model with control perception as a moderator was used to analyze the inner relationship between HL and SPA-M. A cross-sectional survey of 470 people ≥ 60 years old, revealed a significant negative association between HL and medical care avoidance intention, which bootstrapped moderated mediation analysis confirmed is partially mediated by SPA-M. When older people's control perception was high, HL had a significant negative impact on medical care avoidance intention through SPA-M; for low control perception, the effect was insignificant. This study elucidates HL's impact of HL on medical care avoidance, highlighting control perception's relevance to medical care policymaking for older people.

Abstract PR003: Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators

Abstract As a component of statewide cancer needs assessment, this study explored factors impacting colorectal cancer (CRC) screening and approaches to increase screening among Native Americans of Nebraska. Three 75-minute focus groups were conducted October-December 2021: Omaha Urban Indian clinic (n=11), Lincoln Urban Indian clinic (n=6), and Ponca Tribe (n=9). Participants were Native American cancer survivors and caregivers aged 30+ residing in Nebraska. Verbatim transcripts were inductively coded and analyzed using a directed content analysis approach. Most participants were female (88%) and caregivers (85%). Most had heard of colonoscopies (83%), but awareness of fecal tests was low with two participants unaware of any screening. Only 38% had heard of the Fecal Occult Blood Test despite tribal outreach during March incentivizing stool tests. Reasons for low uptake of screening tests included lack of awareness (“What is colorectal cancer?” and “I don't think a lot of Natives get that type of cancer, do they?”), elderly avoidance of medical care (“even when I’m real sick I have to be…near…death” before seeking care), fear (“fearing what they’re gonna find out”), and embarrassment (“perception of manhood”). The invasive and uncomfortable procedural aspect of colonoscopy and use of excreta for stool-based tests "Because I don't wanna be digging in my poop" were other deterrents. Some providers did not strongly recommend the screening. Other barriers include insurance and transportation/travel distance for colonoscopy. Suggested approaches to improve CRC screening were increasing awareness of CRC and screening options using billboards, flyers, posters, brochures, health fairs, public meetings, and social media (e.g., Facebook). Posters and educational materials in clinics were already in use. Suggested message content should portray that CRC is treatable “if they catch it in time,” emphasizing being there for family (“you’ve got kids, you want to see them graduate”), funny (“goofy…they can kinda laugh at the ad and hopefully not be so nervous”) and having community members share CRC survival stories. Engaging the community was also discussed either through 1) having nursing students provide health education outreach, 2) forming elder committees to encourage the elderly to complete screenings, and/or 3) ensuring physicians recommend and explain the importance of screenings during appointments. Community support in terms of transportation, social workers to attend appointments with the elderly, and financial counselors were discussed as important to complete screenings. Certain types of health facilities should enhance their partnership with Native Americans to share information with the community. Low awareness and wrong perception of CRC and screening tests are reasons for low utilization of screening. Participants expressed a desire for the researchers to continue building relationships with the tribal groups to address CRC. The state can use study results to prioritize interventions to reduce cancer care disparities. Citation Format: Krishtee Napit, Kendra L. Ratnapradipa, Lady Beverly Luma, Danae Dinkel, Shinobu Watanabe-Galloway. Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR003.

Effect of COVID-19 pandemic on diagnosis and treatment pattern of prostate cancer: a comprehensive literature review, phase 1

Since its outbreak in late 2019, the COVID-19 pandemic has brought many changes to medical practice, including the care and management methods regarding prostate cancer. Patients with prostate cancer are exposed to high risk of infection, hospitalization, and death due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while other elements including male gender, old age, and pre-existing comorbidities increased the possibility of infection. Although patients with prostate cancer need intensive support and care, high concerns of infection resulted in delay or avoidance of medical care, especially during the initial phase of the pandemic, which led to needs of revisions in diagnostic procedures and treatment plans. Our review illustrates the changes that have occurred in prostate cancer diagnosis, treatment, and prognosis since the emergence of the COVID-19 pandemic. We further conducted a review on topics recently being highlighted which include the protective role of androgen deprivation therapy on SARS-CoV-2 infection, vaccination and immune response in patients with prostate cancer, and the outcomes of altered treatment plans. As with the many efforts in treating cancer since the outbreak of COVID-19, identifying the changes in research and clinical practice of patients with prostate cancer worldwide is essential in providing appropriate patient care in rapidly changing circumstances.

Unmet Medical Needs and Food Insecurity in Children with Neurodevelopmental Disorders: Findings from the 2019 National Health Interview Survey (NHIS).

In the United States, 17% of children ages 3-17 have a developmental disorder. The complexity of care for such children require families to provide a significant amount of health care at home, representing a substantial economic cost. Our study identifies sociodemographic characteristics of children with neurodevelopmental disorders (NDD) that are predictive of unmet medical needs and food insecurity. We modeled the outcomes using a multivariable generalized linear model and a robust Cox proportional hazard model. Among children with NDD, 7.4% reported a delay in obtaining care, 3.6% avoided getting care and 17.3% live in a household that experienced food insecurity. Lack of health insurance and lack of usual source of care increased the risk for cost-related delay in medical care and cost-related avoidance of medical care. Children with NDD whose parents have less than a college degree and those from households with income <$75,000 had increased risk for food insecurity in the past 30 days. Our results underscore the need to implement additional screening to identify children with NDD who are at greater risk for unmet medical and social needs by health care providers and care coordination organizations.

Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer (512)

<b>Objectives:</b> Financial toxicity (FT) impacts approximately 50% of patients with gynecologic malignancies. Still, little is known about factors that predispose patients receiving radiation therapy to financial distress or what impact the COVID-19 pandemic had on their financial well-being. We evaluated FT in patients with gynecologic cancer treated with radiation before and after the start of the COVID- 19 pandemic. <b>Methods:</b> Patients from an urban, academic gynecologic radiation oncology practice completed a survey one month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included demographic questions, the Comprehensive Score for Financial Toxicity (COST) tool, and the EQ-5D to measure the quality of life (QOL). Pandemic-related questions were added during the second survey period (pandemic cohort). As with our prior work, high FT was defined as a COST score of ≤23. We assessed the correlation of COST scores with QOL. We used logbinomial regression to examine associations between FT and costcoping strategies, adjusting for age and insurance. <b>Results:</b> Of 97 respondents (92% response rate), 49% completed the survey before, and 51% completed it after the pandemic started. Among the participants, 76% identified as White, 11% as Black, and 8% as Asian. Most patients had uterine (64%), followed by cervical (24%) and vaginal (6%) cancer. Two-thirds (60%) received external beam radiation with or without brachytherapy; the remaining 40% had brachytherapy alone. The median COST score was 15 (IQR: 7-19) in the high FT group (<i>n</i>=27) and 33 (IQR: 28-36) in the low FT group (<i>n</i>=70). High FT correlated with worse QOL (r=-0.37, p<0.01) and was associated with younger age and type of insurance (both p <0.03). Patients with high FT were more likely to move from full- to parttime employment (22% vs 1%, p<0.01), six (95% CI: 1.0-36) times more likely to delay/avoid medical care, 14 (95% CI: 3-64) times more likely to borrow money, and seven (95% CI: 2-27) times as likely to reduce spending on basic goods. Patients with high FT were more likely to report that decreased ability to work (48% vs 13%), medical bills (41% vs 13%), and transportation or parking (15% vs 3%) mostly contributed to their financial stress (p<0.05 for all). The pandemic cohort had fewer patients with high FT than the pre-pandemic cohort (20% vs 35%, p=0.10) and a higher median COST score (32 [IQR: 25-35] vs 27 [IQR: 19-34], p=0.07). The use of cost-coping strategies did not differ between cohorts. <b>Conclusions:</b> Privately insured, younger patients who received radiation for gynecologic cancer were at risk for FT. High FT correlated with worse QOL and was associated with delays or avoidance of medical care and other cost-coping strategies. The prevalence of high FT was not statistically different before and during the pandemic, though we observed less FT in the pandemic cohort. More work is needed regarding the impact of the COVID-19 pandemic on the financial well-being of patients with cancer.

Patterns of Emergency Medical Transport for Suspected Acute Stroke, Acute Myocardial Infarction, and Other Diagnoses During the COVID‐19 Pandemic: A Retrospective Analysis of a Large Hospital‐Based Emergency Medical Services Agency

Patterns of Emergency Medical Transport for Suspected Acute Stroke, Acute Myocardial Infarction, and Other Diagnoses During the COVID‐19 Pandemic: A Retrospective Analysis of a Large Hospital‐Based Emergency Medical Services Agency

Trends in cancer diagnosis during the SARS-CoV-2 pandemic.

e18584 Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836; 3,717 early pandemic; and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.