DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey

Abstract

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care.

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

“…As already reported by previously published surveys [ 16 , 17 ], in the first pandemic phase, there was an apparent reduction in the activity of the surgical departments, primarily with the reduction in the number of effective beds dedicated to surgical activity: overall the 59% of surgical departments reduced their beds' availability, and 11.9% of them were closed during the phase I of the pandemic. The goal was to redirect nursing and medical-surgical staff to the management of COVID-19 patients, as demonstrated by the fact that about 50% of the departments had at least one member of their staff referred to the care of COVID-19 non-surgical patients.…”

“…Regarding emergency surgery, there was an even more significant contraction of the activity. The inevitable collateral damages that the pandemic brings are the diagnostic delays, the increase in the diagnosis-to-treatment interval for neoplastic diseases, and the delay between neoadjuvant treatment and surgery [ 16 , 18 ].…”

The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study

“…In terms of surgical management, a multi-center study reported a significant delay in diagnostic and therapeutic practices for 70.9% CRC patients. In the delayed patients, 48.9% of respondents reported a change in the initial surgical plan, and 26.3% reported a shift from elective to urgent operations [ 23 ]. In addition, postoperative complications occur in half of infected patients, who are associated with increases in mortality rate of up to more than 20% [ 24 , 25 ].…”

Impacts of the SARS-CoV-2 Pandemic on Young Adult Colorectal Cancer Survivors

“…3 Among 20 surgical societies surveyed internationally, 71% reported disruptions in CRC-related care. 3,7 CRC is also associated with deficits in health-related quality of life, including psychological impairments. 8,9 In addition, due to social distancing measures that attenuated social support networks during the pandemic, CRC patients and survivors may also experience heightened psychosocial distress, including increased anxiety, depression, and reduced coping.…”