Health Services Research and Quality Improvement
The impact of COVID-19 and armed conflict on cancer care in Armenia: A cross-sectional study.
Background: The COVID-19 pandemic has interrupted the spectrum of cancer services, exposing vulnerable cancer patients to significant risks. In Armenia, the negative effect of the pandemic was amplified by the Nagorno-Karabakh war in September-November 2020. We explored the combined impact of the COVID-19 pandemic and armed conflict on cancer care provision in Yerevan, Armenia. Methods: We carried out a cross-sectional survey among all oncologists, nurses, and clinical residents (n = 123) actively providing cancer care to adults and children since 2019 at three publicly-funded institutions in Yerevan, Armenia, namely the National Center of Oncology, Hematology center after prof. R.H.Yeolyan, and Mikaelyan Institute of Surgery. Data collection was conducted between November 1 and December 27, 2021. The survey included 71 items assessing institutional characteristics, COVID-19 diagnoses, disruptions to care, adaptations of care, and availability of human and material resources. Descriptive statistics were used to analyze responses from 89 participants (72%). Results: Disruptions to cancer care during the COVID-19 pandemic were reported due to staff absenteeism (16%) and lack of access to cancer treatment [chemotherapy (14%), radiotherapy (7%), surgery (7%)], elective surgery (27%), intensive care services (10%), diagnostic examinations (3%), and inpatient beds (6%). Shortages of clinical staff for pediatric cancer care were noted by 40% of respondents and were mainly attributed to COVID-19 infection (53%) or self-isolation due to testing positive for COVID-19 (25%). Half of the respondents reported suboptimal cancer patient care and outcomes (e.g. delayed diagnosis and treatment, complications of treatment, elevated mortality rates) caused primarily by the de-prioritization of cancer services during the COVID-19 pandemic. The main issues reported by the respondents during the armed conflict were delays in elective surgery (36%) and staff shortages (17%). Confirmed cases of COVID-19 among patients were reported by respondents as: < 10 (by 6% of respondents), 11-50 (36%), 51-100 (27%) and > 100 (7%). Ten respondents (11%) reported that colleagues had died after contracting COVID-19. Twenty-six percent of respondents reported that the overall rate of hospitalizations decreased during the pandemic and 12% reported increased use of telemedicine. Reductions in material resources were reported by 18% of respondents, while 15% reported funding cuts to their unit by the institution. Conclusions: The COVID-19 pandemic and concurrent armed conflict led to disruptions in cancer care in Armenia, resulting in suboptimal care and outcomes for cancer patients. These findings emphasize the need for proactive planning to maintain standards of cancer care delivery in times of societal crises.