Health Care Utilization before and during the COVID-19 Pandemic in Patients with Epithelial Ovarian Cancer

OBJECTIVES: Telemedicine is an effective tool in managing health in oncology settings while minimizing COVID-19 exposure. Our objective was to evaluate the impact of the pandemic on healthcare utilization and short-term safety outcomes in patients with epithelial ovarian cancer (OC).

METHODS: This retrospective cohort study included patients diagnosed with OC of epithelial subtype between 01/01/2017-06/30/2021 at Kaiser Permanente Southern California (KPSC), an integrated healthcare delivery system. Patients were identified from KPSC’s cancer registry or via chart review. March 4, 2020 was used as the cut-off to define pre-pandemic and pandemic periods. Care utilization outcomes included the number of office visits and virtual visits per person-month, the number of CA125 tests during first course of chemotherapy, and the number of creatinine, complete blood count (CBC), and electrolytes tests per cycle. Short-term safety outcomes included the number of emergency room (ER) visits and hospitalizations per person-month. Bivariate and multivariable negative binomial models were used to evaluate the impact of the pandemic on care utilization and short-term safety outcomes.

RESULTS: Of 799 OC patients included, 581 (72.7%) and 218 (27.3%) were diagnosed during the pre-pandemic and pandemic period, respectively. The mean (s.d.) number of office visits per person-month decreased during the pandemic period [0.4 (0.5) vs 0.6 (0.6) in pre-pandemic, p-value<0.01]. The number of virtual visits during the pandemic was twice that during the pre-pandemic period, after adjusting for age, race/ethnicity, FIGO stage, socioeconomic status, and prior length of healthcare membership [RR (95%CI): 2.04 (1.54-2.72)]. The number of hospitalizations was lower during the pandemic vs the pre-pandemic period [adjusted-RR (95%CI): 0.85 (0.72-1.00)]. No differences in ER visits or laboratory monitoring were observed before and during the pandemic.

CONCLUSIONS: Despite a shift from office visits to virtual visits during the pandemic, no differences in short-term safety outcomes were observed in patients with epithelial OC.