Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management

Abstract

Background: The COVID-19 pandemic has caused disruptions to cancer care by delaying diagnoses and treatment, presenting challenges and uncertainties for both patients and physicians. We conducted a nationwide online survey to investigate the effects of the pandemic and capture modifications, prompted by pandemic-related control measures, on cervical cancer screening-related activities from mid-March to mid-August 2020, across Canada. Methods: The survey consisted of 61 questions related to the continuum of care in cervical cancer screening and treatment: appointment scheduling, tests, colposcopy, follow-up, treatment of pre-cancerous lesions/cancer, and telemedicine. We piloted the survey with 21 Canadian experts in cervical cancer prevention and care. We partnered with the Society of Canadian Colposcopists, Society of Gynecologic Oncology of Canada, Canadian Association of Pathologists, and Society of Obstetricians and Gynecologists of Canada, which distributed the survey to their members via email. We reached out to family physicians and nurse practitioners via MDBriefCase. The survey was also posted on McGill Channels (Department of Family Medicine News and Events) and social media platforms. The data were analyzed descriptively. Results: Unique responses were collected from 510 participants (16 November 2020 - 28 February 2021), representing 418 fully- and 92 partially- completed surveys. Responses were from Ontario (41.0%), British Columbia (21.0%), and Alberta (12.8%), and mostly comprised family physicians/general practitioners (43.7%), and gynecologist/obstetrician professionals (21.6%). Cancelled screening appointments were mainly reported by family physicians/general practitioners (28.3%), followed by gynecologist/obstetrician professionals (19.8%), and primarily occurred in private clinics (30.5%). Decreases in the number of screening Pap tests and colposcopy procedures were consistently observed across Canadian provinces. About 90% reported that their practice/institution adopted telemedicine to communicate with patients. Conclusions: The area most severely impacted by the pandemic was appointment scheduling, with an important level of cancellations reported. Survey results may inform resumptions of various fronts in cervical cancer screening and management.

Competing Interest Statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: MZ and SBP have no conflicts of interest to disclose. RA and EF received MSc. Stipends from the Gerald Bronfman Department of Oncology, McGill University. ELF reports support for the present manuscript in the form of a grant to his institution is his name from the Canadian Institutes of Health Research and the Cancer Research Society; consultancy for Merck; a patent related to the discovery "DNA methylation markers for early detection of cervical cancer", registered at the Office of Innovation and Partnerships, McGill University, Montreal, Quebec, Canada; and financial interests with Elsevier and Elifesciences Ltd in the form of support fees to maintain the editorial office and work as Senior Editor, respectively. No other relationships or activities could appear to have influenced the submitted work.

Funding Statement

The present work was supported by the Canadian Institutes of Health Research (CIHR-COVID-19 Rapid Research Funding opportunity, VR5-172666 grant to Eduardo L. Franco). Eliya Farah and Rami Ali each received MSc. stipends from the Gerald Bronfman Department of Oncology, McGill University.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Faculty of Medicine Institutional Review Board (IRB) of McGill University granted ethical approval for this work.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

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Data Availability

Code files and datasets corresponding to analyses and descriptive figures included in the manuscript and supplement are available online at Borealis, the Canadian Dataverse Repository.

https://doi.org/10.5683/SP3/8MVU6L

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