ABSTRACT
Background and aim: SARS-CoV-2 pandemic has led to a dramatic rearrangement of colorectal cancer (CRC) screening programs until complete suspension in the period March-September 2020,especially in Covid Hospitals. However,the real impact of CRC screening program delay due to pandemic on CRC outcomes has yet to be explored. Aim(s):to evaluate whether screening procedure delays may affect the outcomes of CRC screening. Material(s) and Method(s): we performed a prospective study including all patients undergoing their first screening colonoscopy according to regional CRC program from January 2021 to October 2022 (Group 1-post-Covid), therefore after a 6-month period of CRC screening program suspension (March-September 2020).This group was compared with a historical cohort of patients who underwent first screening colonoscopy in the same Centre from January 2018 to October 2019 (Group 2-pre-Covid).For each group, anthropometric and oncological variables were evaluated,and the effects of delay were evaluated by comparing groups in terms of adenoma detection rate (ADR),cancer rate and stage. Statistical analysis included chisquare, Student's t-test and odds ratio (OR) when indicated. Result(s): finally, 746 screening colonoscopies were performed in the period January 2021-October 2022 (Group 1), as compared with 741 screening colonoscopies in the period January 2018-October 2019 (Group 2). No differences were seen about gender (males 49.6% vs 54%, p=0.1) or age (mean age 63.17+/-6.32 vs 63.77+/-6.47, p=0.07) between the two groups, respectively. Similarly,ADR was 40.9% in the Group 1 vs 45.6% in the Group 2 (p=0.07),although a lower number of adenoma per patient was found in the Group 1 (mean adenoma number per patient 1.58+/-0.94 vs 1.76+/-1.21, p=0.01). A total of 36 CRC were diagnosed in the Group 1 (4.8%), while the CRC rate in the pre-Covid group was 6.6% (49 patients) (p=0.17). However, CRC patients in the Group 1 presented a significantly higher CRC stage when compared with those in the Group 2 (T4 stage 36.1% vs 14.3%, p=0.02, OR 3.39, 95% CI 1.19-9.69),and significantly higher lymph node metastases rate (58.3% vs 30.6%, p=0.01, OR 3.17, 95% CI 1.29-7.79).No differences were seen in the rate of distant metastases (25% vs 12.1%, p=0.1). Conclusion(s): A 6-month screening delay significantly increases advanced CRC cases.Magnitudes of CRC screening delays on prognosis and mortality will be manifest in the next few years.Healthcare systems should adopt policies to preserve the regularity of CRC screening during other Covid-19 waves or pandemics.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19), had two pandemic waves in 2020, respectively in April and November. In the general population, the first wave has been characterized by a higher prevalence in Northern Italy and a higher mortality rate compared to the second one. The aim of this study was to compare the characteristics of IBD patients and negative outcomes of COVID-19 (pneumonia, hospitalization, ventilatory support, death) between the two pandemic waves in Italy. Methods: Prospective observational cohort study. Patients with diagnosis of IBD and confirmed SARS-CoV-2 infection were enrolled. Differences between first and second wave were tested for significance using the Student's t test and Fisher's test, as appropriate. A two-tailed p value <0.05 was indicative of statistical significance. Results: We enrolled 937 IBD patients from 47 participating IBD centres across Italy (219 in the first wave, 718 in the second wave). There were no significant differences between the first and the second wave in terms of age (46.3 ± 16.0 vs. 44.1 ± 15.5 years, p=0.06) and gender (female 45.7% vs. 48.2%, p= 0.54). In the first wave, a lower percentage of patients was affected by Crohn's disease (CD): 92 (42.0%) vs. 399 (55.6%) (p<0.001) while no differences were observed for disease clinical activity: 97/219 (44.3%) vs. 280/718 (38.9%) in the first and second wave, respectively (p=0.18). Regarding biologic therapy, the percentage of patients on biologics in the two waves was similar: 119/219 (54.3%) vs. 393/718 (54.7%) (p=0.94), without differences in anti-TNFalpha, anti-integrins and anti-IL12/23 distribution. During the first wave, a significantly higher percentage of patients were from Northern Italy compared to Central-Southern Italy: 171/219 (78.1%) vs. 387/718 (53.9%), respectively (p<0.001). Overall, COVID-19 negative outcomes were significantly higher in the first wave compared to the second one: 110 (50.2%) vs. 95 (13.2%), respectively (p<0.001). Also the single negative outcomes were significantly higher in the first wave: 61/219 (27.8%) vs. 84/718 (11.7%) had pneumonia, 62/219 (28.3%) vs. 76/718 (10.6%) required hospitalization, 26/219 (11.9%) vs. 39/718 (5.4%) required ventilatory support, and 12/219 (5.5%) vs. 13/718 (1.8%) died (Figure 1). Conclusion: IBD patients had higher number of COVID-19 negative outcomes in the first wave than in second wave. In the first wave, a significantly higher percentage of patients were from Northern Italy, but no significant differences in negative outcomes were observed in comparison with those from Central- Southern Italy. Overall, findings in IBD population are coherent with those observed in the general population. (Table Presented).