COLONOSCOPY COMPLETION AFTER DIAGNOSIS OF RED FLAG SIGN OR SYMPTOM FOR COLORECTAL CANCER DURING THE COVID-19 PANDEMIC

Introduction: As a result of the COVID-19 pandemic, the Veterans Health Administration (VHA) enacted risk mitigation and management strategies in March 2020, including postponement risk for later stage and fatal CRC, if present. Here, we present a study of changes colonoscopy uptake and time to colonoscopy after a red flag diagnosis, pre and postimplementation of COVID-19 policies. Methods: We conducted a cohort study of Veterans ages 50-75 with a red flag sign or symptom for CRC (iron deficiency anemia, hematochezia or abnormal fecal immunochemical blood test [FIT/gFOBT]) receiving VHA care between April 2019 and October 2020. Veterans were grouped based on first red flag diagnosis date into pre-COVID-19 policy (April 2019-October 2019) and post-COVID-19 policy (April October 2020) exposure groups, with a 6-month washout period in between. Primary outcomes were proportion completing colonoscopy and time to colonoscopy completion in policy time window. Covariates included age, sex, race/ ethnicity, marital status, body mass index, Charlson Comorbidity Index score, first red flag sign/symptom and number of red flag signs/symptoms. We examined odds of colonoscopy policy group using multivariable logistic regression, yielding odds ratios (OR) and 95% confidence intervals (95% CI). Results: 33,804 Veterans with red flag signs/symptoms were included (pre-COVID: 19,472;Median age was 68 years (Quartile 1-Quartile 3 [Q1-Q3]: 61-72). Only 32% in the post-COVID group received a colonoscopy, compared with 44% pre-COVID group (p<0.01). Among colonoscopy completers, median time to colonoscopy was significantly different between pre-COVID (median: 65 days;Q1-Q3: 33-140 days) and post-COVID (median: 41 days;Q1-Q3: 20-74 days) groups (p<0.01). In adjusted models, post-COVID group Veterans had 42% lower odds of receiving a diagnostic colonoscopy, compared to those in the pre-COVID group (OR: 0.58, 95% CI: 0.55-0.61). Findings red flag sign/symptom types (Table 2). Conclusions: Lower colonoscopy uptake was observed among individuals with red flag signs/symptoms for CRC post vs. pre-implementation of COVID-19 policies, suggesting future risk for delayed CRC diagnosis and adverse CRC outcomes. However, among completers, time to colonoscopy was shorter post-vs. pre-implementation ofCOVID-19 policies, perhaps attributable to prioritization of individuals needing diagnostic vs. less urgent procedures. Further work is needed to understand and address potential impact of COVID-19 on timely CRC diagnosis and overall CRC outcomes.(Table presented)

Policy coordination and housing outcomes during COVID-19

Prior to the COVID-19 pandemic the housing system in Australia was under strain. Policy makers in Australia were braced for severe, detrimental impacts arising from the unfolding global pandemic. The response from all tiers of Australian government to these threats was rapid and comprehensive, and where required, coordinated. Broad estimates suggest that > $4 billion was allocated for new and expedited policy interventions at key points of the housing system. Good outcomes were achieved through coordinated action in some key policy areas, which provides broader lessons for how policy makers can address existing challenges in the housing system and respond to future crises with system-level implications. © 2020 Australian Housing and Urban Research Institute. All rights reserved.