Impact of Delay in Healthcare Access on Anal Cancer Diagnosis

COVID-19 pandemic caused a significant disruption in healthcare services, leading to a reduction in routine check-ups as well as a shift towards virtual care. This resulted in many patients delaying or avoiding seeking medical attention for symptoms, which led to delay in diagnosis, especially for conditions such as anal cancer that require a physical examination and diagnostic endoscopy. This study aimed to highlight the impact of healthcare disruptions and resultant impact on advanced stage of anal cancer diagnosis.

This is an audit of all patients at a large academic centre who presented with anal canal squamous cell carcinoma between 2018 and 2022. Time/year of presentation, tumour size, presence of nodal and metastatic disease, and primary treatment at the time of presentation was collected for analysis. Kruskal-Wallis, Fisher-Freeman-Halton, and Chi-square tests were used as statistical measures to compare tumour sizes and overall stage.

One hundred forty-five patients with histological diagnosis of anal canal squamous cell carcinoma were seen between 2018 and 2022. A significantly higher proportion of patients presented with locally advanced, nodal, or distant metastatic disease in the years during and after COVID-19 healthcare delivery disruption (1/4/2020-31/3/2023). In the years post-COVID-19, a higher proportion of patients were diagnosed with metastatic disease at presentation. Furthermore, patients were more likely to be treated with palliative intent radiotherapy and chemotherapy in later years of healthcare disruption compared to years prior to restrictions placed by COVID-19.

This data suggests that changes in patient messaging and limited healthcare access during the COVID-19 pandemic negatively impacted the presentation of anal cancer patients. After the onset of the COVID-19 pandemic, disruptions in normal patient care led to patients presenting with more advanced disease and specifically metastatic disease.