An observational study of the demographic and treatment changes in a tertiary colorectal cancer center during the COVID‐19 pandemic

Abstract

Background and Objectives: The COVID-19 pandemic has wreaked havoc in the healthcare infrastructure. While we change our surgical practice, cancer care will take a toll on unprecedented long-term outcomes. We elucidate our experience that has unfolded during this period. Methods: This study included retrospective data of patients being treated for colorectal cancer and peritoneal surface malignancy between January and May 2020. We compared the treatment changes before and after the national emergency was declared. Results: There was a 65% decrease in outpatients with a 90% drop in endoscopy procedures. Treatment protocols were changed with a 200% increase in short course radiation in rectal cancer. Colon cancer and anal melanoma were triaged to undergo 'essential' surgery. No robotic or exenteration procedures were performed in April and May. Patients with a low peritoneal cancer index underwent surgery alone. The relative number of emergency surgeries were unchanged. Conclusion: There is no standard approach to deliver cancer care during the COVID-19 pandemic. Treatment decisions were made based on the state of affairs that COVID-19 had created during that cross-section of time and protocols were redrawn to strike a balance between the risk of death from colorectal cancer and the risk of death from COVID-19 infection.

Melbourne colorectal collaboration: a multicentre review of the impact of COVID‐19 on colorectal cancer in Melbourne, Australia

“…In the United Kingdom, the ‘Preventing Viral Pandemic Associated Risk of Cancer Death’ (PREVAIL) 11 criterion has been adapted to prioritize treatment for patients with CRC, by preventing disparities in diagnosis, surgical intervention and non‐surgical treatment options. Some centres have also seen a decrease in outpatients, reduction in endoscopy procedures due to safety concerns regarding aerosol generation, and an increase in short course radiation in rectal cancer 5,9,12 . There were major changes in the delivery of treatment, and the number of operations decreased and surgical methods were adapted to minimize COVID‐19 risk.…”

Impact of Covid-19 pandemic on a general surgery clinic

“…Changes were reported in Asia as well. For example, China, the start point of this pandemic, reported a decreased rate of 35% for patients undergoing elective surgery; India was no exception, showing a decrease of 42.4% [ 16 , 17 ].…”

“…It should be noted that with the evolution of the pandemic and its waves, the percentage of elective interventions began to increase, mainly in the cases of patients with oncological diseases. The Covid-19 pandemic has immediate and long-term effects on millions of patients with surgical conditions, and it is expected to lead to additional requests for surgical services once this period ends [ 4 , 5 ].…”

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

“…Es bleibt somit ein potenzielles Risiko der intraoperativen SARS-CoV-2-Transmission im Rahmen kolorektaler Eingriffe bestehen und somit sind die eingangs erwähnten Sicherheitsmaßnahmen weiterhin zu empfehlen. [23].…”

“…Auch die Studien aus Großbritannien berichten von einer deutlichen Abnahme laparoskopisch durchgeführter Operationen (von 59 % auf 26 %) und einer häufigeren Anlage an Stomata (von 44 % auf 56 %). Aus Indien wird eine Zunahme von Kurzzeitbestrahlungen beim Rektumkarzinom von 200 % berichtet [ 23 ].…”