Quantifying the impact of the COVID‐19 pandemic on gastrointestinal cancer care delivery

Abstract

Background and Aim This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID‐19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. Methods and results Patients diagnosed with a GI malignancy (ICD10: C15‐C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre‐pandemic (weeks 1–10) and early pandemic (weeks 11–20) study periods. Difference‐in‐difference analyses adjusted for week‐specific and year‐specific effects quantified the impact of the COVID‐19 pandemic on care delivery between pre‐pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID‐19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) ( p = 1.2 × 10 −4 ), Radiology encounters ( p = 1.9 × 10 −7 ), Surgery encounters ( p = 1.6 × 10 −3 ), Radiation Oncology encounters ( p = 4.1 × 10 −3 ), and infusion visits (6.1 × 10 −5 ). Subgroup analyses revealed cancer‐specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs ( p = 7.1 × 10 −5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r 2 = 0.722, p = 2.1 × 10 −10 ). Conclusions The COVID‐19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.

The COVID-19 Pandemic and In-Person Visit Rate Disruptions Among Patients With Hematologic Neoplasms in the US in 2020 to 2021

“…This cohort study used patient data from a nationwide, EHR-derived deidentified clinical database to assess associations between the COVID-19 pandemic and in-person and telemedicine visit rates among patients with a broad range of indolent and aggressive hematologic neoplasms. Although several studies have evaluated changes in cancer care delivery during the pandemic, most have focused on solid organ tumors and did not evaluate visit rates in relation to therapy type . We observed a significant decline in in-person visit rates for oral therapy and outpatient infusions during the early pandemic period in all hematologic neoplasm subtypes, which later returned to forecasted rates after June 2020.…”

“…Although several studies have evaluated changes in cancer care delivery during the pandemic, most have focused on solid organ tumors and did not evaluate visit rates in relation to therapy type. [8][9][10] We observed a significant decline in in-person visit rates for oral therapy and outpatient infusions during the early pandemic period in all hematologic neoplasm subtypes, which later returned to forecasted rates after June 2020. Our results mirror the findings from population-based and registry studies in other ambulatory care settings 6,22,23 and reflect disruptions from the stay-at-home orders that were in place in most of the US during that period.…”

“…Studies examining the association between the pandemic and cancer care delivery are limited. Some studies in solid organ neoplasms have suggested a trend toward delay in care and treatment modifications during the early pandemic period . However, how the pandemic affected in-person visit rates and telemedicine use among patients with hematologic neoplasms is unknown.…”

Influence of the COVID-19 pandemic in the gastrointestinal oncology setting: An overview

“…Of note, most patients do not wish to change their treatment plans as recommended by guidelines developed during the pandemics[ 25 ] and this may be due to the fear and insecurity in face of the chance of having a worse prognosis because of a decrease in the frequency of care measures. Another American study that compared 25666 patients being treated for gastrointestinal cancer in 2020 and 23530 patients followed up in 2019, observed that there were statistically significant decreases in the number of radiotherapies and surgeries in patients with gastrointestinal neoplasms[ 26 ]. Sozutek et al [ 27 ] recently observed a reduction of about 70% in the volume of cases of colorectal cancer at an academic center during the pandemic.…”