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Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A
Catherine L Forse1, Stephanie Petkiewicz1, Iris Teo1
1Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada.
Background:
In March 2020, a directive to halt all elective and non-urgent procedures was issued in Ontario, Canada because of COVID-19. The directive caused a temporary slowdown of screening programs including surveillance colonoscopies for colorectal cancer (CRC). Our goal was to determine if there was a difference in patient and tumour characteristics between CRC patients treated surgically prior to the COVID-19 directive compared to CRC patients treated after the slowdown.
Methods:
CRC resections collected within the Champlain catchment area of eastern Ontario in the 6 months prior to COVID-19 (August 1, 2019-January 31, 2020) were compared to CRC resections collected in the 6 months post-COVID-19 slowdown (August 1, 2020-January 31, 2021). Clinical (e.g., gender, patient age, tumour site, and clinical presentation) and pathological (tumour size, tumour stage, nodal stage, and lymphovascular invasion) features were evaluated using chi-square tests, T-tests, and Mann-Whitney tests where appropriate.
Results:
Three hundred and thirty-eight CRC specimens were identified (173 pre-COVID-19, 165 post-COVID-19 slowdown). CRC patients treated surgically post-COVID-19 slowdown had larger tumours (44 mm vs. 35 mm; P = 0.0048) and were more likely to have presented emergently (24% vs. 10%; P < 0.001). Although there was a trend towards higher tumour stage, nodal stage, and clinical stage, these differences did not reach statistical significance. Other demographic and pathologic variables including patient gender, age, and tumour site were similar between the two cohorts.
Interpretation:
The COVID-19 slowdown resulted in a shift in the severity of disease experienced by CRC patients in Ontario. Pandemic planning in the future should consider the long-term consequences to cancer diagnosis and management.
Insights
The COVID-19 pandemic's temporary halt on procedures led to larger colorectal cancer (CRC) tumors and more emergent presentations in patients undergoing surgery in Ontario. Future pandemic planning must address the impact on cancer diagnosis and care.
Area of Science:
- Oncology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic prompted a directive in Ontario, Canada, to pause elective and non-urgent medical procedures.
- This directive led to a temporary slowdown in cancer screening programs, including surveillance for colorectal cancer (CRC).
Purpose of the Study:
- To investigate differences in patient and tumor characteristics of colorectal cancer (CRC) patients.
- To compare CRC patients treated surgically before the COVID-19 directive versus those treated after the procedural slowdown.
Main Methods:
- A comparative analysis of colorectal cancer (CRC) resections was conducted.
- Specimens from eastern Ontario, collected in the 6 months prior to (August 2019-January 2020) and post-COVID-19 slowdown (August 2020-January 2021), were evaluated.
- Clinical and pathological features were assessed using chi-square, T-tests, and Mann-Whitney tests.
Main Results:
- 338 CRC specimens were analyzed (173 pre-slowdown, 165 post-slowdown).
- Patients treated after the COVID-19 slowdown presented with significantly larger tumors (44 mm vs. 35 mm) and were more likely to have emergent presentations (24% vs. 10%).
- Trends toward higher tumor, nodal, and clinical stages were observed but did not reach statistical significance; other variables were similar.
Conclusions:
- The COVID-19 pandemic-induced slowdown shifted the disease severity in colorectal cancer (CRC) patients.
- Findings underscore the need to consider long-term consequences for cancer diagnosis and management in future pandemic preparedness plans.
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