Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study

Abstract

Background There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. MethodsData were extracted from four population-based datasets spanning NHS England (the National Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated.Findings As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stomaforming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020.Interpretation The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England.

Impact of the COVID-19 Pandemic on Surgical Treatment Patterns for Colorectal Cancer in a Tertiary Medical Facility in Korea

“…The emphasis on social distancing, which led to a reluctance to visit hospitals because of fear and worry of COVID, resulted in delayed diagnosis and treatment of malignant diseases, including colorectal cancer. These delays inevitably resulted in postponed or rescheduled clinical procedures [ 31 , 32 ]. This made the extent of surgical interventions wider and increased postoperative complications.…”

Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries

“…1 3-8 Therefore, assessment of the full impact of the pandemic on mortality should include both the doi: 10.1136/bmj.n1137 | BMJ 2021;373:n1137 | the bmj direct effect of the pandemic on deaths from covid-19 and the indirect effect of the pandemic on deaths from other causes, as might be expected from the disruption to health services or from wider economic and social changes. [9][10][11][12][13][14][15][16][17] Assessing the overall impact of the pandemic on mortality requires measurement of "excess deaths," calculated as the difference between the number of deaths from all causes that occurred during the course of the pandemic and the expected number of deaths based on a historical baseline from recent years. [18][19][20][21] Mortality below the expected levels is called "avoided mortality" or "mortality deficit," whereas "mortality displacement" (or "harvesting") is characterised by a period of excess deaths followed by a period of mortality deficit (see glossary in supplementary materials for more information).…”

“…Measures taken to handle the covid-19 pandemic have also varied substantially across countries 1345678. Therefore, assessment of the full impact of the pandemic on mortality should include both the direct effect of the pandemic on deaths from covid-19 and the indirect effect of the pandemic on deaths from other causes, as might be expected from the disruption to health services or from wider economic and social changes 91011121314151617…”

How is the pandemic affecting non-covid services?

“…Cancer— Between April and October 2020 around 3500 fewer patients than expected were given a diagnosis of bowel cancer in England 6…”