While some of that will be related to so-called long COVID, caring for patients whose symptoms continued after a viral infection, other efforts will be focused on the consequences of delayed and decreased care.
A good example of what occurred is how access to care for men with prostate cancer declined sharply during the worst of the COVID-19 pandemic. A study using data from a specialty-wide, community-based urology registry sought to determine trends in outpatient prostate cancer (PCa) care during the novel coronavirus outbreak. The study was accepted as part of the 2021 American Society of Clinical Oncology (ASCO) annual meeting this month.
The effort was led by University of California San Francisco researchers; they note that 3,165 (̃25%) of U.S. urology providers, from 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry. That registry collects data through automated extraction from electronic health record systems.
Researchers analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. The focus was on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage. Defined as the primary outcome was mean weekly visit volume by PCa patients per practice; visits were defined as all physician and mid-level practitioner visits, both telehealth and face-to-face. They then compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019.
For the 267,691 PCa patients in AQUA who received care between 2019 and 2020, the magnitude of the decline and recovery varied by risk stratum, with the sharpest drops for low-risk PCa between weeks 10 to 44.
For 2020, the study team determined that overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks at 25. That plummeted 31%—to about 18—compared with 2019 until week 14 and then recovered to 2019 levels by week 23 before declining steadily to 11.89—a 58% decline from 2019—as of week 44 when the analysis ended.
“Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November,” the researchers concluded. “This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.”
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