Impact of the COVID‐19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer

Suárez, Javier; Mata, Elena; Guerra, A; Jiménez, Gloria Mateo; Montes, Marta; Arias, Fernando; Ciga, M. A.; Ursúa, Eugenia; Ederra, María; Arín, Beñat; LaIglesia, Matilde; Sanz, A. Pedregosa; Vera, Ruth

doi:10.1002/jso.26263

Cited by 59 publications

(78 citation statements)

References 15 publications

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“…While Belgium registered high numbers of deaths attributed to COVID-19 (with or without PCR confirmation), excess mortality during the first wave of the COVID-19 pandemic was comparable to average levels for Europe. 26 Despite the varied impact of the pandemic and the diversity of confinement measures to slow the spread of COVID-19 around the world, single-center and multicenter studies, from Italy, 5 , 15 Germany, 13 Austria, 12 Slovenia, 9 Poland, 2 Spain, 11 the UK, 1 and the USA, 3 , 4 , 6 , 14 as well as nationwide, population-level studies from the Netherlands 16 and Denmark, 17 all support a global decline in cancer diagnosis during the early stage of the pandemic. The scarcity of large, population-based studies on cancer diagnoses during the pandemic, to date, is presumably linked to delays in data collection.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Likewise, single-center and multicenter studies, and population-level studies focused on specific tumor types have reported declines in numbers of cancer diagnoses. 1 , 2 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Evidence from large-scale studies quantifying these declines on a population level is limited. Two nationwide studies, from the Netherlands 16 and Denmark, 17 reported declines in the overall number of cancer diagnoses in March 2020 and March to May 2020, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis

Peacock¹,

Tambuyzer²,

Verdoodt³

et al. 2021

ESMO Open

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Background: Oncological care was considerably impacted by the COVID-19 pandemic. Worrisome declines in diagnostic procedures and cancer diagnoses in 2020 have been reported; however, nationwide, population-based evidence is limited. Quantification of the magnitude and distribution of the remaining outstanding diagnoses is likewise lacking. Methods: Using accelerated delivery of data from pathology laboratories to the Belgian Cancer Registry, we compared the nationwide rates of new diagnoses of invasive cancers in 2020 to 2019. Results: We observed a 44% reduction in total diagnoses of invasive cancers in April 2020 compared with April 2019, coinciding with the first wave of the COVID-19 pandemic. The reduction was largest in older patients and for skin cancers (melanoma and nonmelanoma). Reductions in diagnosis were less pronounced among children and adolescents (0-19 years). A smaller decline was observed for most cancers with typically poorer prognosis or obvious symptoms, including some hematological malignancies, lung, and pancreatic cancer. Suspension of organized population screening programs was reflected in a strong decline in diagnosis in the screening age groups for female breast cancer (56%) and for colorectal cancer in both men (49%) and women (60%). The number of diagnoses began to increase from the end of April and stabilized at the beginning of June at or just above 2019 levels. There has yet to be a complete recovery in cancer diagnoses, with an estimated 6%, or w4000 diagnoses, still outstanding for all of 2020. Among solid tumors, head and neck cancers have the largest remaining year-over-year decrease in diagnoses at 14%. Conclusion: These results add to the evidence of a profound impact of the COVID-19 pandemic on oncological care and identify groups at risk for continuing diagnostic delays. These data should stimulate health care providers worldwide to facilitate targeted, accessible, and efficient procedures for detection of cancers affected by this delay.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis

Peacock¹,

Tambuyzer²,

Verdoodt³

et al. 2021

ESMO Open

View full text Add to dashboard Cite

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“…[17][18][19] Some examples are limitations of access to screening programmes, to medical care cancer-related visits (both in primary care and in hospitals), to cancer diagnostic tests, reduction in scheduled cancer surgeries due to limited access to postsurgical critical care units and occupation of hospital beds by patients with COVID-19, reduction of treatments that could pose a high risk to the patient in the circumstances of the pandemic, and modifications of therapeutic guidelines, among others. [18][19][20][21] In some countries, a reduction in cancer diagnostics and cancer encounters was observed. [22][23][24] This led to a reduction in new cancer diagnoses and a delay in cancer treatment.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

et al. 2021

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ObjectiveCancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care.DesignTime-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm.Main outcome measuresWe obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status.ResultsBetween March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that).ConclusionsReduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.

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“…The COVID-19 pandemic stopped or slowed many CRC screening programs. This interruption will have a great impact on the number of CRCs diagnosed and on the prognosis of newly diagnosed cases, which will, presumably, be diagnosed at an advanced stage (12)(13)(14). Resuming these programs is becoming a priority, but unfortunately, the new rules for preventing COVID-19 transmission have reduced the availability of colonoscopies in most health system (1,2,15).…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

et al. 2021

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Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

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Impact of the COVID‐19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer

Cited by 59 publications

References 15 publications

Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis

Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

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