Implications for health system resilience: Quantifying the impact of the COVID-19-related stay at home orders on cancer screenings and diagnoses in southeastern North Carolina, USA

Abstract

COVID-19 impacted hospital systems across the globe. Focus shifted to responding to increased healthcare demand while mitigating COVID-19 spread on their campuses. Mitigation efforts limited medical professional-patient interactions, including patient access to preventive cancer screenings. Data were gleaned from a health information exchange containing records on over 2 million patients in southeastern North Carolina, USA. This study tested five hypotheses: H₁: Weekly cancer screenings significantly decreased during North Carolina's (NC) Stay-At-Home (SAH) orders; H₂: Weekly cancer diagnoses significantly decreased during NC's SAH orders; H₃: Weekly cancer screenings significantly increased after the end of NC's SAH orders; H₄: Weekly cancer diagnoses significantly increased after the end of NC's SAH orders; and H₅: Weekly advanced cancer diagnoses significantly increased after the end of NC's SAH orders. Time series regression analysis was employed to quantify trends. Results suggested strong support of H₁ and H₃, moderate support of H₄, mixed support of H₅, and no support of H₂. For example, compared to before the SAH orders, we estimated 662.3 fewer weekly breast cancer screenings during the SAH orders (H₁). After the SAH orders (H₃), we estimated 232.5 more breast cancer screenings and 10.6 more breast cancer diagnoses. This work quantifies the impact of COVID-19 associated SAH orders on cancer screenings and diagnoses and suggests the potential for delayed or missed cancer diagnoses. This evident disruption in providing routine medical care also highlights the importance of strengthening health systems (or organizations) and improving resilience to natural disasters and infectious disease outbreaks.

Keywords: COVID-19; Cancer; Diagnosis; Screening; Time series analysis.