How State Cancer Plans Responded to the COVID-19 Pandemic
By Jason Semprini, PhD, MPP
While many of us would prefer to forget the uncertainty and terror we confronted during 2020, the lessons we learn (or refuse to learn) will profoundly shape future public health systems. This is especially true for cancer prevention and control systems. As the pandemic became an officially declared Public Health Emergency, two dire predictions about people with cancer came to be true.
The first prediction was elevated risk of death and susceptibility to severe complications from a COVID-19 infection. Compared to the general population, people with cancer died much more frequently from COVID-19. The second prediction was that lockdowns, closures, and social distancing measures would disrupt cancer care services. In 2020 alone, health systems eventually missed over 100,000 cancer diagnoses.
While typically used to validate predictions or cast blame, the power of 20/20 hindsight vision is most responsibly used within a continuous quality-improvement framework. A crucial component of a high-capacity health system, quality improvement promotes effectiveness, trust, and transparency; where the only failure is failing to learn. Under such a quality improvement framework within the context of the COVID-19 pandemic, cancer prevention and control systems would monitor and evaluate how they responded to the pandemic, then use the lessons learned to adapt existing or implement new strategies.
With the goal of informing effective and transparent cancer prevention and control strategies, I evaluated how states responded to the COVID-19 pandemic. Specifically, I evaluated state cancer control plans. Given the vast landscape of cancer prevention and control players, these cancer control plans help align strategies and coordinate implementation efforts within a state. Each state has a cancer control plan. Here is Iowa’s plan. While these plans receive funding and technical assistance from the Center for Disease Control and Prevention (CDC), the contents of and process to create these plans are left to the discretion of each state and stakeholders. Essentially, these plans serve as a blueprint or road map for improving cancer outcomes within each state.
My peer-reviewed evaluation was quite simple. Beginning in October 2022, I first obtained every state cancer plan. I excluded plans that were last updated before March 2020. Among plans updated on or after March 2020, I conducted a keyword search for “COVID” terms. I then qualitatively analyzed the plans which included “COVID” terms to identify common themes and differences among these responsive plans.
In the end, only 7 states adapted their plans in response to the COVID-19 pandemic. These states included Illinois, Maine, Nevada, North Carolina, Utah, Vermont, and our home state Iowa. Most states adapted their plan in response to the pandemic by meeting specific care needs by addressing specific service delivery issues, with some attention to health equity.
“IA specifically cited the COVID-19 pandemic as rationale for adapting their plan to improve cancer screening and clinical trial participation. The new IA plan prioritized specific screening initiatives related to public awareness and targeted community outreach, removing system barriers to screening, advocating for policies to increase patient access, and enhancing the availability of genetic risk assessments. (Semprini 2024).”
Iowa’s plan specifically aimed to respond to the challenges brought about by the COVID-19 pandemic by increasing cancer screening rates and clinical trial participation by addressing workforce shortages. I found this response to be highly in tune with the reality facing Iowa’s cancer prevention and control system. Long before March 2020, many areas in Iowa have experienced prolonged healthcare workforce shortages. However, even though the pandemic did not cause workforce shortages in Iowa, the pandemic could exacerbate the shortages. In response to such a dire outlook, Iowa’s new plan aimed to address workforce shortages at various levels.
“IA’s plan explicitly called out the dire effects of the pandemic on workforce shortages and trust in public health; calling for renewed commitments and investment in both aspects of cancer care. One priority created detailed action steps to increase and diversify IA’s oncology workforce. Beginning with early education resources to grow the pool of potential healthcare providers to competitive financial packages to support the retention of current physicians and nurses.” (Semprini 2024)
Most importantly, I found that states appeared to understand the importance of addressing social determinants of health within cancer plans. Iowa was no exception. In fact, Iowa’s plan dedicated an entire chapter to health equity. This chapter reiterated the likelihood that the pandemic would exacerbate existing disparities across the cancer control continuum.
Were these the right responses during an international public health emergency? That is not my job, nor is it any one person’s job to make such a claim. Were these cancer plan adaptations effective? Perhaps with time and sufficient attention, we’ll someday find out. Being right is far less important than getting [it] right. All we can say now is that Iowa’s Cancer Control Plan, which is already quite slick as a living document compared to other states’ archaic PDFs, appeared quite responsive and attune to the needs of cancer survivors and control systems in the early months of the COVID-19 pandemic. While responsiveness is a goal itself, it is also a means to continuous quality improvement.
As the COVID-19 public health emergency moves farther into the rearview, we must not let the lessons we learned fade away. Iowa’s cancer control plan serves as an example for future quality improvement processes, underscoring the need for responsive and adaptive public health systems. Even if we cannot yet predict what the next crisis may be, by evaluating the successes and learning from the challenges experienced during this particular emergency, we can create a more responsive health system that ensures all Iowans will be cared for in times of any crisis.
About the Author
Jason Semprini, PhD, MPP, is a health services researcher who investigates the impact of policies on health. He is an Assistant Professor at Des Moines University in the Department of Public Health. He holds a PhD in Health Services & Policy from the University of Iowa and a Master’s in Public Policy from the University of Chicago.