COVID‐19 and the emergency presentation of colorectal cancer

Abstract

Aim:The COVID-19 pandemic led to widespread disruption of colorectal cancer services during 2020. Established cancer referral pathways were modified in response to reduced diagnostic availability. The aim of this paper is to assess the impact of COVID-19 on colorectal cancer referral, presentation and stage. Methods: This was a single centre, retrospective cohort study performed at a tertiary referral centre. Patients diagnosed and managed with colorectal adenocarcinoma between January and December 2020 were compared with patients from 2018 and 2019 in terms of demographics, mode of presentation and pathological cancer staging. Results: In all, 272 patients were diagnosed with colorectal adenocarcinoma during 2020 compared with 282 in 2019 and 257 in 2018. Patients in all years were comparable for age, gender and tumour location (P > 0.05). There was a significant decrease in urgent suspected cancer referrals, diagnostic colonoscopy and radiological imaging performed between March and June 2020 compared with previous years. More patients presented as emergencies (P = 0.03) with increased rates of large bowel obstruction in 2020 compared with 2018-2019 (P = 0.01). The distribution of TNM grade was similar across the 3 years but more T4 cancers were diagnosed in 2020 versus 2018-2019 (P = 0.03). Conclusion:This study demonstrates that a relatively short-term impact on the colorectal cancer referral pathway can have significant consequences on patient presentation leading to higher risk emergency presentation and surgery at a more advanced stage. It is therefore critical that efforts are made to make this pathway more robust to minimize the impact of other future adverse events and to consolidate the benefits of earlier diagnosis and treatment.

The impact of the COVID‐19 pandemic on colorectal cancer diagnosis and management: a Binational Colorectal Cancer Audit study

“…This multi-institutional, binational data substantiate the work of Shinkwin et al In their study of 272 patients from a single institution, 11 they showed that the impact of COVID-19 had been a T-stage shift, with a higher proportion of patients diagnosed with T4 cancers at index presentation. In our analysis, we looked at overall stage and found a significant shift as well, from Stage I to more II and III.…”

“…2 A single centre study of 272 patients concluded significantly more T4 cancers were diagnosed in 2020 due to COVID-19 restrictions versus 2018-2019 (p = 0.03). 11 Modelling has estimated there may be an increase of up to 16.6% in avoidable deaths from colorectal cancer. 12 The first wave resulted in a 92% reduction in colonoscopies and 31% less surgery for colorectal cancer.…”

Did the COVID-19 lockdown result in a delay of colorectal cancer presentation and outcomes? A single centre review

“…Secondly, different countries have implemented various strategies to ease the impact of COVID-19 on their healthcare systems, and to reduce the chance of COVID-19 transmission from within hospitals to the community via patients. In other high-income countries [ 6 – 10 ], one strategy has been through restricting the availability of cancer screening. In addition, an international study by Glasbey et al spanning 20,006 solid organ cancer patients across 61 countries demonstrated that full lockdowns due to COVID-19 directly delayed elective cancer operations in 1 in 7 patients [ 11 ].…”

“…Delays in presentation of CRC are known to increase the mortality and morbidity of the disease, by resulting in a higher stage of CRC at diagnosis [ 16 ]. International studies have shown how a country’s decision to reduce screening measures had resulted in more CRC patients presenting at a higher stage of disease or as an emergency admission [ 8 – 10 ].…”

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions

“…Moreover, there is also consistent evidence of higher rates of cancer-related emergencies and more advanced stages at detection due to COVID-19. A single center study at a tertiary care center in the UK found that over the entire year, 2020 saw a significant increase in patients presenting with emergent large bowel obstructions and T4 cancers at diagnosis than both 2018 and 2019 [23]. Mizuno et al describe greater rates of emergent CRC cases due to complete large bowel obstructions in a cohort of patients who underwent surgery in a cancer treatment center in Japan during the first state of emergency [24].…”