Nancy L. Schoenborn|Cynthia M. Boyd|Craig Evan Pollack
Impact of the COVID?19 pandemic on cancer screening attitudes, intentions, and behaviors in older adults
Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University
though covid19 pandemic led substantial decline cancer screening rates studies focused older adults13 older adults higher risk severe covid19 infection recommended take extra caution reduce exposure therefore older adults may likely younger adults postpone cancer screening pandemic delay screening pandemic experience unprecedented public health crisis may also affected older adults attitudes intentions towards cancer screening better understanding pandemics impact older adults attitudes intentions towards cancer screening inform efforts remedy negative effects pandemic optimize postpandemic cancer screening practices crosssectional survey november 19 2020december 4 2020 using nationally representative online panel knowledgepanel details supporting information4 examined selfreported screening behaviors attitudes since covid19 pandemic breast colorectal prostate cancer screenings panel members aged 65 older invited one three survey versions cancer type response rate 722 685 breast cancer 738 colorectal cancer 744 prostate cancer participants categorized choosing screen delay screen included screened pandemic due screening hypothetically would choose screening delay included delayed would delay screening asked reasons delaying screening impact pandemic interest screening perceived value screening intentions resume screening collected information demographics political affiliation singleitem medical maximizerminimizer question mm15 perceived cancer risk6 enthusiasm towards cancer screening7 concern covid19 health literacy8 healthfunctional status used predict 10year mortality risk9 perceived safety getting screening used national data calculate countylevel covid19 case rates 2 weeks study10 used univariable multivariable logistic regression identify characteristics associated choosing screen versus delay due sample size constraints regression models pooled data across cancer types survey weights applied adjust nonresponse 585 participants breast cancer 212 women prostate cancer 205 men colorectal cancer 84 women 84 men majority white 765 mean age 738 years 300 perceived screening time survey less safe prepandemic table s1 enthusiasm cancer screening high among 413 participants already stopped screening 691 agreed screening cancer long one lives overall 293 446 participants either screened 163 would choose screening 283 pandemic whereas 120 208 participants either delayed 132 would delay screening 77 rest stopped screening pandemic figure 1 univariable models age predicted 10year mortality risk race education health literacy local covid19 case rate concern covid19 significantly associated choosing screen versus delay whereas screening enthusiasm perceived screening safety response mm1 significantly associated outcome table s2 three variables included multivariable model high screening enthusiasm associated higher odds odds ratio 180 95 confidence interval ci 108300 choosing screen versus delay compared lower levels enthusiasm perceived screening safe prepandemic also likely choose screen versus delay ors 415 95 ci 249692 478 95 ci 2141067 compared perceiving screening less safe response mm1 longer reached statistical significance multivariable model among 120 participants delayed would delay screening common reasons concern covid19 exposure 458 seen doctor pandemic 211 thought screening 155 majority 634 planned resume screening 259 neutral 13 participants 108 plan resume screening interest screening perceived value screening largely unchanged among 413 participants already stopped screening 71 reported less interest cancer screening longterm 111 reported interest 43 considered cancer screening less worthwhile prepandemic whereas 184 considered screening worthwhile despite studies describing decline cancer screening rates earlier pandemic13 older adults pandemic dampen interest cancer screening may enhance enthusiasm cancer screening overall one possible explanation pandemic highlighted importance health health care given numerous uncertainties pandemic older adults may inclined optimize health cancer screening one action important assess whether findings persist longterm older patients appropriate candidates cancer screening results suggest clinicians recommend continuing resuming cancer screening without much worry patient reluctance highlighting safety screening may important counseling older patients screening cessation appropriate clinicians recognize enhanced screening enthusiasm may contribute hesitancy stopping screening adapt discussion screening cessation accordingly authors conflicts interest dr pollack stock ownership gilead sciences inc dr cynthia boyd received small payment uptodate coauthored chapter multimorbidity believe resulted conflict design methodology results presented manuscript dr schoenborn full access data study takes responsibility integrity data accuracy data analysis design study nancy l schoenborn cynthia boyd craig e pollack data analysis nancy l schoenborn data interpretation nancy l schoenborn cynthia boyd craig e pollack preparation manuscript nancy l schoenborn review revision manuscript nancy l schoenborn cynthia boyd craig e pollack project made possible k76ag059984 grant national institute aging addition dr boyd supported 1k24ag056578 national institute aging funding sources role design methods subject recruitment data collections analysis preparation paper appendix s1 supporting information please note publisher responsible content functionality supporting information supplied authors queries missing content directed corresponding author article