Cancer screening and first-time visits to oncology services during and after COVID-19 pandemic in Uruguay.

Lucia Beatriz Delgado Hospital de Clínicas, Montevideo, Uruguay info_outline Lucia Beatriz Delgado, Natalia Camejo, Cecilia Castillo, Nicolas Vacca, Bruno Camargo, Gabriel David Krygier

Authors Lucia Beatriz Delgado Hospital de Clínicas, Montevideo, Uruguay info_outline Lucia Beatriz Delgado, Natalia Camejo, Cecilia Castillo, Nicolas Vacca, Bruno Camargo, Gabriel David Krygier Organizations Hospital de Clínicas, Montevideo, Uruguay, Servicio de Oncologia Clinica, Hospital de Clínicas, University of Uruguay, Montevideo, Uruguay, Honorary Commission for the Fight Against Cancer (CHLCC), Montevideo, Uruguay, Hospital de Clinicas, Montevideo, Uruguay Abstract Disclosures Research Funding No funding sources reported Background: On March 13, 2020, Uruguay confirmed the first cases of COVID-19 and the same day the government declared a Public Health Emergency that was extended until April 4, 2022. The measures implemented to mitigate the transmission included, among others, postponing screening studies and in-person consultations. Added to these measures was the fear of going to health centers and the consequences of the economic crisis, with the increasing difficulties in traveling and facing the co-payments necessary to access health services. This study aims to evaluate the impact of the COVID-19 pandemic on cancer screening and first time- visits to oncology services during the public health emergency and following its lifting. Methods: We compare the number of PAP test, mammograms and fecal immunochemical test (FIT) reported by the same comprehensive health providers during 3 periods: pre-pandemic (2018-2019), public health emergency period (March 13, 2020- April 4, 2022) and post-public health emergency (April 5 2022-June 30,2023). Cancer screening data was obtained from the screening registry of the Honorary Commission to Fight Cancer (CHLCC) and first oncology visits from the Oncology Electronic Health Record (HCEO). Health providers that report PAP, mammograms, and FIT cover around 90%, 30%, and 40% of health system users, respectively, and those that use HCEO, 40%. Results: After two years of COVID-19 public health emergency, the number of reported PAP smears test, mammography and fecal occult blood test, decreased by 26%, 46% and 33% respectively (Table 1). The reduction was greater during the first months of the pandemic and during the peak of the first wave (April-June 2021: PAP -50%, mammography -58%, occult blood test: -70%). Likewise, the number of first-time visits to oncology services decreased by 37%, reaching a 56% decline during the first wave. As shown in Table 1, these declines continued after the health emergency was lifted. Conclusions: Our results show an important decline of cancer screening and first-time visits to oncology services during the pandemic in Uruguay. After emergency was lifted, reported PAP test showed a partial recovery but mammography, occult fecal blood test and first-time visits to oncology services remain well below pre-pandemic levels. Percentage decrease in the number of reported screening tests and first-time oncology visits by the same health providers during and after the COVID-19 health emergency in Uruguay. % Decrease During Health Emergency % Decrease After Health Emergency Total Number Decrease PAP smear test 1 (ASSE 2 and private providers) -26% -10% 180.090 Mammography 1 (private providers) -46% -42% 115.033 Fecal occult blood test 1 (private providers) -33% -60% 55.136 First-time visits or oncology services (ASSE, private providers) -37% -42% 15.348 1: Own elaboration based on the screening registry-CHLCC. 2: State Health Services Administration.