Management of colorectal cancer in the era of COVID-19: Challenges and suggestions

Abstract

The Coronavirus (COVID-19) pandemic had a huge impact on all sectors around the world. In particular, the healthcare system has been subject to an enormous pressure that has surpassed its ability in many instances. Additionally, the pandemic has called for a review of our daily medical practices, including our approach to colorectal cancer management where treatment puts patients at high risk of virus exposure. Given their higher median age, patients are at an increased risk for severe symptoms and complications in cases of infection, especially in the setting of immunosuppression. Therefore, a review of the routine colorectal cancer practices is needed to minimize risk of exposure. Oncologists should weigh risk of exposure versus the patient’s oncologic benefits when approaching management. In addition, treatment protocols should be modified to minimize hospital visits and admissions while maintaining the same treatment efficacy. In this review, we will focus on challenges that colorectal cancer patients face during the pandemic, while highlighting the priority in each case. We will also discuss the evidence for potential modifications to existing treatment plans that could reduce infectious exposure without compromising care. Finally, we will discuss the impact of the socio-economic difficulties faced by Lebanese patients due to a poor economy toppled by an unexpected pandemic.

Melbourne colorectal collaboration: a multicentre review of the impact of COVID‐19 on colorectal cancer in Melbourne, Australia

“…13 Moderate level evidence also suggests that delayed resection of colorectal cancer worsens survival and it has been proposed that primary surgery for early-stage colorectal cancer should not be postponed for more than 6 weeks due to risk of cancer progression or related complications. [15][16][17][18] In our collaborative study from five institutions, comparing Pre-COVID-19 and COVID-19 period, there was no delay from initial GP referral to being seen in Colorectal clinic and there was no significant delay from diagnosis to the patient receiving their operation. This could be due to the early introduction of telehealth clinics which allowed timely clinic reviews, despite restrictions in face-to-face consultations.…”

“…This was most likely due to hospital preparedness and availability of resources rather than to geographical factors 13 . Moderate level evidence also suggests that delayed resection of colorectal cancer worsens survival and it has been proposed that primary surgery for early‐stage colorectal cancer should not be postponed for more than 6 weeks due to risk of cancer progression or related complications 15–18 …”

Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis

“…The rapid worldwide spread of the new SARS-CoV 19 virus led to the implementation of unprecedented confinement measures in order to minimize the dissemination of the Coronavirus-19 disease (COVID-19). At the same time, healthcare systems around the world were restructured in order to confront the pandemic; hospitals were closed or were repurposed into COVID-19 treatment centers, most prominently by suspending outpatient clinics and elective surgeries [ 1 ]. These radical measures have prevented people from carrying out annual medical screening or seeking medical advice [ 1 , 2 ].…”

“…At the same time, healthcare systems around the world were restructured in order to confront the pandemic; hospitals were closed or were repurposed into COVID-19 treatment centers, most prominently by suspending outpatient clinics and elective surgeries [ 1 ]. These radical measures have prevented people from carrying out annual medical screening or seeking medical advice [ 1 , 2 ]. Newly diagnosed cancer cases were significantly lower in 2020 compared to the pre-pandemic era [ 3 , 4 ], while cancer-related deaths were also significantly increased during the same time period [ 5 ].…”

Papel da telemedicina em pacientes com câncer avançado durante a pandemia de covid-19: Uma revisão integrativa / Role of telemedicine in patients with advanced cancer during the covid-19 pandemic: An integrative review

“…Já em uma pesquisa autoadministrada sobre manejo virtual de pacientes com câncer durante a pandemia, disponibilizada para oncologistas, foi relatado que as dificuldades encontradas na forma de teleatendimento residem em falta de exame físico, possível falta de conscientização e de acesso tecnológico dos pacientes, dificuldades no manejo do suporte da tecnologia de informação e falta de segurança do gerenciamento virtual (TASHKANDI et al, 2020). Outro achado foi que os principais desafios do cuidado paliativo em alguns pacientes com câncer durante a pandemia de COVID-19 são falta de suporte social, sofrimento psicológico, desconfiança do cuidador, dificuldade da prescrição de opióides por telesaúde e rápido declínio do status de saúde (ALAM et al, 2021).…”