The impact of COVID-19 pandemic on colorectal cancer patients at an NHS Foundation Trust hospital-A retrospective cohort study

Abstract

Introduction Current NHS guidelines recommend that treatment of colorectal patients referred through the two-week wait referral system should occur within sixty two days from the date of referral. The COVID-19 pandemic which started in March 2020 has however led to significant delays in the delivery of health services, including colorectal cancer treatments. This study investigates the effects of delayed colorectal cancer treatments during the COVID pandemic on disease progression. Methods A retrospective chart review of 107 patients with histologically confirmed diagnosis of colorectal cancer was conducted. The occurrence of cancer upstaging after initial diagnosis was assessed and compared between patients with treatment delays and patients who received treatments within the period recommended by NHS guidelines. A logistic regression was performed to evaluate the association between treatment delays beyond 62 days and cancer upstaging. Results The median age of the cohort was 71.2 years and 64.5% of the patients were over 65 years. Treatment delays were observed in 53.3% of reviewed patients. Patients with treatment delays received cancer treatments 95.8 (31.0) days on average after referral, compared to 46.3 (11.5) days in patients who experienced no treatment delays (p-value<0.0001). 38.6% of patients with treatment delays experienced cancer upstaging by the time of treatment, compared to 20% in the non-delay group (p-value = 0.036). Patients who received treatment after sixty two days from date of referral were 3.27 times more likely to experience colorectal cancer upstaging compared to those who received timely treatments. Conclusion Although an effective response to the Covid-19 pandemic requires the reallocation of healthcare resources, there is a need to ensure that treatments and health outcomes of patients with chronic diseases such as colorectal cancer continue to be prioritized and delivered in timely fashion.

The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients

“…The authors, therefore, concluded that the worse 1-year survival rate was attributable to the infection itself rather than to the impact of the pandemic on the health system or tumor stage. 81 However, real-life data with longer follow-up are needed to confirm this interesting finding as other studies previously mentioned have reported changes in CRC staging 52 and treatment delays 76 associated with the pandemic, so this finding may differ if analyzed in other populations.…”

“…Almost 40% of patients with treatment delay were diagnosed with cancer upstaging at the moment of start treatment (odds ratio: 3.27) compared with patient who received timely treatment. 76 A modeling study performed in England estimated the effect of a 3–6 months delay of the oncologic surgery on the survival (age specific and stage specific) of different cancers, balancing it with the outcomes of an equivalent volume of COVID-19 hospitalizations. For CRC, the survival was markedly affected even by these modest delays to surgery, with a reduction in the 5-year net survival around 30% for stage III CRC in all age groups.…”

Emergency Department Admission Rates, Waiting Times, and Mortality: An Observational Study in the Tertiary Center Most Proximal to Gaza During a Military Conflict

“…Similar reductions in referral of medical cases with accompanying increased mortality have been observed with COVID-19. 10,11 This finding may have several causes. Disruption of common referral pathways, such as reduced availability of pharmaceutical services, primary care physicians and outpatient testing and may have led to a reduction of the quality of care for chronic diseases and even decreased or late disease detection.…”

“…Similar reductions in referral of medical cases with accompanying increased mortality have been observed with COVID-19. 10,11…”

The Challenges of Colorectal Cancer Surgery during the COVID-19 Pandemic in Romania: A Three-Year Retrospective Study

“…In order to limit patients’ access to elective therapies and be ready for the arrival of COVID-19 patients, hospitals were reorganized [ 7 ]. As a direct consequence of this, the majority of hospitals were forced to reallocate their resources (equipment and workforce) to the treatment of COVID-19 patients, and many elective visits and surgeries that were already booked were pushed back for several weeks [ 8 ]. Because of their concerns about contracting an infection, a significant number of cancer patients felt hesitant to seek care, which put them in a position where their disease was more likely to develop.…”