Modelling the impacts of COVID-19 pandemic on the quality of population-based colorectal cancer screening

Abstract

COVID-19 pandemic has severely affected regular public health interventions including population-based cancer screening. Impacts of such screening delays on the changes in structure and screening process and the resultant long-term outcomes are unknown. It is therefore necessary to develop a systematic framework to assess theses impacts related to these components of quality. Using population-based cancer screening with fecal immunochemical test (FIT) as an illustration, the main analysis was to assess how various scenarios of screening delays were associated with the capacity for primary screening and full time equivalent (FTE) for colonoscopy and impact long-term outcomes based on a Markov decision tree model on population level. The second analysis was to quantify how the extent of COVID-19 epidemic measured by social distancing index affected capacity and FTE that were translated to delays with an exponential relationship. COVID-19 epidemic led to 25%, 29%, 34%, and 39% statistically significantly incremental risks of late cancer for the delays of 0.5-year, 1-year,1.5-year, and 2-year, respectively compared with regular biennial FIT screening. The corresponding statistically findings of four delayed schedules for death from colorectal cancer (CRC) were 26%, 28%, 29%, and 30%, respectively. The higher social distancing index led to a lower capacity of uptake screening and a larger reduction of FTE, resulting in longer screening delay and longer waiting time, which further impacted long-term outcomes as above. In summary, a systematic modelling approach was developed for demonstrating the strong impact of screening delays caused by COVID-19 epidemic on long-term outcomes illustrated with a Taiwan population-based FIT screening of CRC.

Nimble Approach: fast, adapting, calculating and ethically mindful approach to managing colorectal cancer screening programmes during a pandemic

“…This is in alignment with lessons learnt from other disasters in regard to interruption of cancer screening services 44. Using the Nimble Approach is also likely to mitigate the impact of COVID-19 on incidence and mortality as modelling studies show that screening programmes that can minimise delays have a more modest impact on these outcomes 45–49. However, impact on other outcomes like stage of diagnosis are likely inevitable for those with delayed diagnosis.…”

“…Open access programmes that can minimise delays have a more modest impact on these outcomes. [45][46][47][48][49] However, impact on other outcomes like stage of diagnosis are likely inevitable for those with delayed diagnosis.…”

Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

“…Because guaiac fecal occult blood test can also detect heme in some foods (for example, red meat), people must avoid certain foods before having this test. It is supposed to be repeated annually[ 6 , 8 , 13 , 15 , 28 - 30 ].…”

“…In response to the pandemic, there were global policy decisions like lockdown and stay at home orders that were aimed at preventing the spread of the virus. Unfortunately, these decisions resulted in the inability of patients with chronic diseases to access healthcare[ 4 - 6 ]. There was also redistribution of both human and material resources in the hospital setting to tackle the pandemic.…”

“…A malignancy of such incidence and mortality significance, with projected worldwide incidence of 2.5 million new cases by 2030[ 11 , 12 ], should be managed without much delay even in the face of a pandemic. But, management of CRC was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy[ 6 , 8 , 13 - 18 ].…”