COVID-19 and colorectal cancer – signs of a toxic relationship and how to break the cycle: a single institution, tertiary centre experience

Abstract

Colorectal cancer (CRC) is one of the most prevalent oncological diseases globally, taking 3 rd place in incidence in the general population. High in mortality, it is also a form of cancer whose outcome is highly dependable on its stage at diagnosis. therefore, many countries have adopted a more or less successful screening process to ensure early diagnosis and, in turn, higher survival rates and better results overall. The COVID-19 pandemic has altered the established medical routines worldwide, with massively postponing diagnostic procedures and elective surgeries. This study aims to measure the effect the pandemic has had on colorectal cancer treatment in our institution. Variables such as deferral time from diagnosis to commencement of treatment, lapse of time between different phases of the treatment process, time of presentation (elective versus emergent surgery), the physical status of the patient at the time of surgery (ASA classification) and metastatic index (positive lymph node ratio), were taken into account. We juxtaposed data from patients treated at the Surgical Department of Clinical Hospital Center in Zagreb in 2019 and 2020, the latter being heavily affected by the pandemic. In 2019 and 2020, 347 and 314 patients, respectively, with c18-c20 diagnoses (International Statistical Classification of Diseases and Related Health Problems ICD-10), have been treated at our Hospital. With exclusion criteria applied, the patient count falls to 173 for 2019 and 157 for 2020. these numbers include operated cases with or without an anastomosis formation and with or without neoadjuvant chemotherapy applied. From the analysis we excluded patients with recurrent colorectal tumors, synchronous and metachronous tumors, and patients treated palliatively. Furthermore, colorectal adenomas were also excluded from the study. Our data shows significant difference between observed variables in the two patient groups, attributed to the COV-iD-19 pandemic. since there is still no reliable way to predict the duration of this global health crisis, it is imperative to implement strategies to lessen the damaging effect the pandemic has had on favourable oncosurgical treatment outcomes in colorectal cancer patients.

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

“…Five case-series studies, conducted at an institutional level, compared the number of colorectal cancer procedures performed during the pandemic to that performed during preceding years, pre-COVID-19; one of the studies was from an UMIC (China) and four were from HICs (Italy, Romania, Croatia) [ 39 , 57 , 68 , 70 , 75 ]. The relative percentage reduction in the institutional volume of elective colorectal procedures performed ranged from 11.08%–57.3% across these studies [ 39 , 57 , 68 , 70 , 75 ].…”

“…Eleven of the 18 studies that reported on elective surgery activity were undertaken at an institutional level, which limited their statistical power to show a difference [5,26,39,57,[68][69][70][71][72][73]75]. Case performance reductions were not caused solely by elective surgery service suspensions; ancillary pandemic-or patient-specific determinants are tabulated (Table 5).…”

Lack of information on colorectal cancer in general public might be the reason for low response rates to screening progam

“…the peak incidence is around and after the age of sixty. in croatia, over 3,500 patients are diagnosed annually, and over 2,100 people die from the disease, making colon cancer the second most often malignant cause of death in the population of croatia (1,3). the national program for early Detection of colon cancer has been implemented in croatia since 2007 by the Ministry of Health in cooperation with regional public health institutes and qualified endoscopists.…”