Modifications to Treatment Plan of Rectal Cancer in Response to COVID-19 at the Philippine General Hospital

Abstract

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression.Methods: This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated.Results: Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality.Conclusion: Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study

“…The histopathological upstaging of colorectal cancer is another issue that has been speculated to be associated with delays in recognizing the symptoms of colorectal cancer, its diagnosis, and colorectal cancer surgery during the pandemic period [ 1 13 18 23 24 ]. In Uyan et al’s study [ 1 ], for instance, the authors found higher rates of emergency operations and more patients with N and M stages for colorectal cancer during the COVID-19 pandemic.…”

Surgical safety in the COVID-19 era: present and future considerations

“…Also, the Society of Surgical Oncology recommends neoadjuvant therapy for resectable pancreatic cancer and selected gastric cancer cases as a temporary measure during the pandemic [ 50 ]. Although resection of primary cancer is the treatment of choice for most gastrointestinal malignancies, advances in adjuvant treatments have provided clinicians with alternative measures to cope with the current circumstances [ 51 52 53 ].…”

“…A hasty or obstinate selection of surgical resection is thus unnecessary in positive COVID-19 cases if other treatment modalities are available. Furthermore, the use of telehealth or telemedicine applications, in which clinicians assess and manage patients without direct contact, has also emerged and been adopted rapidly as a countermeasure [ 51 64 65 66 ].…”

Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version

“…However, poor prognostic factors, such as the rate of unresectable stage IV disease, increased preoperative carcinoembryonic antigen levels, and peritumoral lymphatic invasion in patients with stage I-II diseases, were significantly increased in the COVID-19 epidemic population [26]. Another study reported that delayed treatment to prevent the transmission of COVID-19 infection resulted in disease progression in patients with rectal cancer during the quarantine period [27]. The COVID-19 pandemic is not yet over.…”