Health

A little swelling didn't seem to be a cause for concern in the midst of a global pandemic.

It all started so gradually that Pat Wales just can't explain. She felt great while vacationing in Mexico in late summer 2019 and then noticed her belly was slowly expanding months after they returned to Westminster.

Something went wrong, but then COVID-19 appeared and the problem didn't seem urgent enough to get medical attention amidst all of this.

"I was under the impression that there was no point in making an appointment because of something as insignificant as a tumor," she said.

Although the swelling can be caused by many relatively benign conditions, Wallis, 83, didn't get good news when she finally saw a doctor in March 2021. She had ovarian cancer that had progressed to stage 3B, meaning she had spread to other parts of the abdomen but not to distant organs. It's hard to tell when the cancer stopped being treatable, but an early diagnosis could save it the prospect of continuing to fight a relapse.

"It will be an endless loop until I die," she said.

It's unclear how many people in Colorado could be in a similar situation, suffering from conditions that could have been controlled or treated but spiraled out of control when their medical care was disrupted by COVID-19. Several key health services in Colorado have yet to return to pre-pandemic levels, but it could be years before anyone knows if that has led to a measurable increase in premature deaths.

Cancer screenings and regular health club visits declined in 2020 both in Colorado and across the country, and while they increased again in 2021, that wasn't enough to make up for last year's losses. While full data for 2022 is not yet available, experts believe patients have not yet fully tackled the treatment they were deferring.

"Overall, the big picture is that services are back to pre-pandemic levels," said Julius Chen, assistant professor of health care policy and management at Columbia University. "We expect to see more than pre-pandemic levels."

The extent of this problem depends on what help was lost and what services were lost. If a generally healthy young person misses a scheduled visit to a health club, they are at less risk than someone who is not seeing a doctor for high blood pressure and diabetes.

Dr. Teuta Shemshedini, ob-gyn at Boulder Valley Women's Health Center, said it was a "wonderful balance" to bridge the gap for people who want to recover sooner during the pandemic, while also making room for receipt. . high risk in the near future.

At the Women's Health Center, they've added appointments on Friday afternoons to serve more people, made it easier to schedule mammograms and Pap smears online, and launched social media promotions to try to reach people who may be targeted, Shemshedini said for other purposes. According to him, the "bottleneck" is starting to clear up, but demand remains high.

"We're probably not out yet, but we're taking some positive steps," he said.

Cancer screening tests in Colorado have declined

Across the country, breast, cervical and colorectal cancer screening rates recovered quickly after a stay-at-home order in spring 2020, but then declined again through the end of 2021, according to a Trilliant study. Health on approximately 300 million people. healthcare organization, it was done. service analysis company.

The statewide data didn't look at the graph that closely, but it did show that by the end of 2021, Colorados were still not receiving pre-pandemic cancer screenings. Colorado ranked fourth in the steep decline in cervical cancer screening rates from the fourth quarter of 2017 to the fourth quarter of 2021 and sixth in the steep decline in breast cancer screening rates over the same period. In both cases, the state shifted from the top half of subjects to its bottom half residents.

However, Colorado has seen one of the smallest declines in colorectal cancer detection and has actually moved up the rankings.

It's not clear why the results vary so much by type of cancer screening, said Ali Oakes, director of research at Trilliant Health. Even before the pandemic, a combination of factors had impacted detection rates, including trust in the healthcare system, insurance coverage and the ease with which patients could make an appointment, he said.

There may be a number of reasons why screening rates remained low in 2021: people may be concerned about the cost of health care as they face other rising costs, they may remain reluctant to seek in-person treatment out of fear or more likely they will ignore their doctors' advice if they believe the threat of COVID-19 is exaggerated, Oakes said.

"We certainly haven't seen the rebound needed to make up for the outlook we lacked in 2020," he said. "It's hard to say it's just about COVID, but COVID has changed the paradigm."

It's still too early to tell the exact impact, Oakes said, but some health systems have seen an increase in the number of patients diagnosed with metastatic cancer in 2021 compared to pre-pandemic levels. It's hard to say how much of this increase is due to the pandemic, as the number of cancer screenings began to decline in 2017.

Most of the data on the consequences of delayed care comes from European countries with centralized health systems. A recent British study showed a 26% drop in lung cancers diagnosed during the first three months of the pandemic, followed by a 2.2% increase in cancers diagnosed in stage four, the most severe stage.

It's not the people who put off mammograms or colonoscopies for months, but the ones who never do and are years late, Chen said. Some people's tumors grow faster than others, he says, but a delay of several years makes it more likely that cancer will be diagnosed when it's no longer treatable.

At least in the first year of the pandemic, fewer people were treated for cancer on the Front Range. From March to December 2020, cancer-related visits were about 22 percent lower than in the same period in 2019, with the largest decline seen for breast cancer, according to a Colorado Institute of Health report. Since there is no concrete reason to believe that the incidence of cancer has decreased so dramatically, it can be assumed that some people either did not know they had the disease or knew and felt they should delay treatment.

During most of this period, people were not prohibited from asking for help. Colorado's ban on non-emergency procedures, implemented out of concerns that the state lacks personal protective equipment to care for COVID-19 patients and others in emergencies, was in effect only from March 23 to April 26 2020.

Ellie Morgan, director of internal research at the Colorado Institute of Public Health, said the lockdown order was just one of many factors contributing to the drop in cases. Some people who could get help were afraid of catching the virus in their doctor's office, while others felt they were "doing their part" by not contacting non-emergency resources, she said at the webinar.

Various drops of care.

According to the Colorado Institute of Health, visits to all health care workers in the Front Range region were down about 25 percent from March to December 2020. Visits to health care centers were down the most, with fewer people than expected being screened for hypertension, diabetes and high cholesterol.

Visits for depression, anxiety and substance use disorders also decreased, as did emergency room visits. The numbers include telehealth visits, and without them, the decline would have been even sharper, Morgan said.

Some visits may not have taken place because people didn't contract common respiratory viruses or get hurt by staying home, said Spencer Budd, a policy analyst at the Colorado Institute of Public Health. However, that doesn't explain the extent of the decline, he said.

Although outpatient visits have returned to near-normal levels as of September 2020, Budd said they have not reversed the spring-summer decline.

"There was no rush to make appointments," she said.

Providers typically don't have as many open appointments, so it's not as easy as moving everyone who received their scheduled medical care in April 2020 a few months later, the doctor says. Greg Berman, chief medical officer. This was stated by the CEO of Kaiser Permanente Colorado. . It has been easier for them to reach people because their system delivers most of the care at home, meaning that a patient who shows up for an eye exam can be referred for lab testing during the same visit. or blood pressure monitoring. he said.

"You already have reservations for May and June because there is normal demand," he said.

Berman said Kaiser Permanente Colorado saw 8-10% more visitors in 2022 than usual before the pandemic. Some patients, particularly those with compromised immune systems, aren't yet entirely comfortable receiving in-person care, she said, so they've increased phone and video visits to try to connect with these people.

"You have to make it very easy and convenient for your patients," she said. "We want to close these gaps in care."

The state lacks data on restoring the full range of medical services in the second year of the pandemic. An analysis of Colorado's All Payers database data found that routine doctor visits did not reach pre-pandemic levels in 2021, although they were close for people with commercial insurance or Medicare Advantage plans.

A report from the Colorado Institute of Public Health raises concerns about those who are not receiving medical care, at least in the early stages of the pandemic. People aged 65 and older and people with asthma, diabetes, high cholesterol or high blood pressure are more likely than other adults to not receive health care. For Asian Whites and Coloradians, the decline was greater than for other ethnic groups, and for children ages 2 to 4, the decline was greater than for older children.

Part of the difference may simply reflect who is more likely to be treated first, as healthy young people tend to see doctors less often than older adults, people with chronic illnesses and children who need regular vaccinations and checkups, Budd said. . It's also possible that older adults and people with underlying health conditions were more concerned about the virus and preferred to avoid cleaning themselves, she said.

Colorados continue to face spending delays

As of this spring, some Colorado residents were still reporting delayed treatment. According to a Colorado Health Foundation Pulse survey in April 2022, about 45 percent said they had put off getting medical or dental care at some point in the past year. It was the summer of 2021 when about 39% of people said the same thing.

Colorados who were uninsured or feared losing it were more likely to delay calling for help. As well as those who have reported food safety issues, people with disabilities and those who have said they have been discriminated against in healthcare settings. It's unclear how many people would have said the same before the pandemic because healthcare costs have been a concern for years.

Shemshedini said he is seeing growing anxiety from patients about the possibility of unexpected health care costs as inflation has already hit many people's budgets. And, of course, finding regular help isn't for everyone, especially people of color, immigrants and LGBTQ people, she said.

"I think we need to be a little more proactive with people," she said.

Wales, a Westminster woman who has been putting off seeking medical treatment that could have caused her cancer sooner, urged others to get tested for unusual symptoms, even if they seem minor.

In April 2021, he underwent surgery and chemotherapy and in mid-January he had to have surgery again after doctors discovered he had spleen cancer. She hopes to start another round of chemotherapy in a few weeks and knows the cancer will likely return at some point.

"Don't overlook the little things," she said.

Sign up for our weekly newsletter to get health updates delivered to your inbox.

Tarakaratnanu benguliruki vechavnumpu..! || TDP Mannava Mohana Krishna on Taraki Ratna Health Update || TV5