COVID-19 Pandemic–Related Outcomes in High-Risk Gastrointestinal Cancers—Beyond the Numbers

Abstract

Janczewski and colleagues 1 contribute to the literature with a comprehensive comparison of pandemic-related differences, including incidence, stage at diagnosis, 1-year survival, and 30-day and 90-day operative mortality, in patients with high-risk gastrointestinal (HRGI) cancers. This retrospective cohort analysis was performed using the National Cancer Database (NCDB) with data comparison extending from the prepandemic years (including 2018 and 2019) to the height of the COVID-19 pandemic through 2020. To our knowledge, this report is the largest retrospective study examining pandemic-related outcomes data for patients with HRGI cancers. According to their findings, 1 the observed outcomes data in 2020 paralleled those of the prepandemic years studied.The effects of the global COVID-19 pandemic on cancer care, including delays in screening, diagnosis, and treatment, have been established in the literature. 2,3 Understandably, however, the impact of these setbacks on various cancer types was not uniform. Overall, pandemic-related outcomes data among patients with HRGI cancers are sparse. Those with HRGI cancers, including esophageal, gastric, pancreatic, and primary liver cancer, comprise a particularly susceptible subgroup because these cancers commonly harbor distinctly aggressive tumor biology. Timely diagnosis and a multidisciplinary approach to treatment are paramount, and surgical intervention, which experienced delays at institutions worldwide throughout the pandemic, is the cornerstone of cure for these patients. Therefore, one would hypothesize that disruption of screening and treatment pathways, as caused by the pandemic, would have nefarious consequences within this patient population. The analysis performed in this study 1 would suggest otherwise.The authors 1 report that although the incidence of HRGI cancers declined in early 2020 (March to May) compared with 2018 to 2019, the number of newly diagnosed cases reached prepandemic levels without rebound effect through the remainder of 2020. These results were consistent across the 4 groups studied. 1 These findings align with the results of the CAPANCOVID study, 4 which selectively evaluated pandemic-related outcomes on patients with pancreatic adenocarcinoma. The fact that no rebound effect was evidenced in either study 1,4 is largely suggestive of missed diagnoses as a result of the COVID-19 pandemic. Conversely, the short 3-month window of a reduction in new cases reported by the authors 1 indicates that medical professionals treating patients with HRGI cancers were innovative and prudent in combating the systemic hurdles facing screening and diagnostic strategies in this patient population and should be commended.In terms of pandemic-related implications for gastrointestinal tumor staging, results from previous retrospective studies are mixed, and data are not well elucidated. Higher proportions of advanced-stage colorectal cancer have been reported, 3 whereas the Italian multicenter retrospective COVID-AGICT study 5 did not find significant diff...