Behavioral changes and delayed colorectal cancer diagnosis during COVID-19: a real-world survey analysis

The coronavirus disease 2019 (COVID-19) pandemic profoundly altered healthcare systems and patient behavior worldwide, resulting in a significant decrease in hospital visits and delays in diagnosis and treatment. Thus, we aimed to investigate behavioral changes in patients undergoing colorectal cancer surgery during the pandemic, identify vulnerable populations, and determine the impact of such changes on cancer progression.

We conducted a comprehensive survey of patients who underwent colorectal cancer surgery at Osaka University Hospital and Minoh City Hospital between January 2021 and June 2023. Participants were asked about their clinical symptoms, regular and additional medical visits, and screenings. Behavioral changes were defined as pandemic-related postponements or cancellations of additional screenings and regular medical visits. Clinical and pathological data were collected retrospectively from medical records.

Among the 98 patients who completed the survey, 83 met the inclusion criteria (43 males, average age 70 years). Behavioral changes due to the pandemic were observed in 8.4% of patients. Clinical symptoms, particularly rectal bleeding, were more common in the latter part of the study period (P = 0.014). Women were more likely to change their behavior (P = 0.038), and the disease stage tended to be more advanced in patients who changed their behavior (P = 0.062).

The COVID-19 pandemic led to significant behavioral changes, resulting in delayed medical consultations and more advanced cancer diagnoses. These findings highlight the need for robust public health strategies to promote regular medical checkups and timely screening, especially among vulnerable groups, during global health crises.