• Neil S Wenger, Annette L Stanton, Ryan Baxter-King, Karen Sepucha, Lynn Vavreck, and Arash Naeim.
• Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA. nwenger@mednet.ucla.edu.
• J Gen Intern Med. 2022 May 1; 37 (6): 145014561450-1456.

BackgroundCOVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need.ObjectiveTo determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements.DesignFour nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020.Participants59,747 US adults who completed 15-min online surveys. 69% cooperation rate.MeasuresPhysical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk.Key ResultsOf the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December.ConclusionsCancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.© 2021. The Author(s).

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