ABSTRACT
Background: Effective Cancer screening is critical in reducing cancer related mortality in CRC by increasing the detection in earlier stages. Worldwide, practically all cancer pathways have been negatively affected by the implications of the COVID-19 pandemic. Oncological care has not escaped the effects of reprioritization of health care services to handle the surge of COVID-19 patients adequately. Cancer screening programs are no exception as many were temporarily halted to alleviate the pressure on overwhelmed health care systems. In Uruguay, the first covid patients were detected in March 2020, and since then, the country's Public Health policies have been marked by the covid-19 public health emergency. The aim of this study is to assess the impact of the COVID-19 pandemic on CRC diagnosis. We further aimed to analyze the effect on the clinical presentation and stage at diagnosis during 2020-2021 compared with previous years. Methods: This was a retrospective cohort study performed at a single tertiary center. Patients diagnosed and managed with colorectal adenocarcinoma during the years 2020-2021 were compared with patients from 2018-2019. Those enrolled in 2018- 2019 were classified as the “pre-pandemic group”, and those enrolled in 2020-2021 were classified as the “pandemic group”. The primary outcome was the rate of stage IV disease at the time of diagnosis. Mann-Whitney test was used in the comparison of quantitative variables and Fisher's exact test was used for qualitative variables. Results: A total of 370 patients were included in this study. From March 2018 to 2019 (pre-pandemic), 217 patients were considered, and from March 2020 to 2021 (pandemic), 153 patients. Median age of pre-pandemic and pandemic group was 64.4 and 65.6 years, respectively. There was no statistically significant difference in cancer obstruction or perforation at diagnosis. Patient demographics and tumor clinicopathological features were comparable. The percentage of surgical candidates was lower during the pandemic (69% vs 62%). There was a significant difference in TNM tumor distribution between pre-pandemic and pandemic subgroups with a higher incidence of advanced (cT4 or cN+ or M1) tumors. T4 tumors and node positive disease were equivalent in both groups but the incidence of disseminated disease (cM1) was significantly higher in the pandemic group (P < 0.001). Conclusions: Our study demonstrates how cancer diagnostic variables, mainly stage at diagnosis, have been affected by the impact of the COVID-19 pandemic on cancer screening programs. Therefore, it is of utmost importance that cancer diagnosis and treatment pathways be reinstalled in full to return to and build on pre-pandemic priority to ensure the benefits from earlier diagnosis and treatment. Future studies are needed to verify the tendency in stage migration and to optimize CRC care in the pandemic scenario.
ABSTRACT
Background: After the government declared a health emergency due to COVID-19 on March, 2020, the Mastology Teaching Unit (UDAM) providing care to breast cancer patients tried to ensure adequate oncological care, and to protect patients from the virus infection and serious complications due to a possible state of immunosuppression. Towards this objective, the Department of Clinical Oncology developed guidelines with some treatment modifications. Objective: To assess the health care activities of the UDAM during the period considered as the “peak” of the pandemic, since its beginning to June 30, 2020. Methods: This is an observational study that collected data from the electronic clinical record system called Oncology Electronic Health Record (HCEO) during the aforementioned period. Results: There werea total of 293 medical appointments (221 in person), through which 131 patients were attended to. The number of medical appointments decreased by 16.7% compared to the same period in 2019 (352 appointments). Of the patients who were attended to during the “peak” period, 109 (83.2%) were on systemic onco-specific treatment and 22 (16.8%) were attended to for disease control. The medical appointments were scheduled to evaluate the continuity of treatment and treatment modifications if necessary (95 patients;72.5%), for disease control (17;12.9%), for first-time consultation (12;9.1%) and to assess paraclinical studies (7;5.3%). The patients were on hormone therapy (HT) (81 patients;74%), chemotherapy (CT) (21;19%), and anti-HER2 therapies (9;8%). A total of 20 treatments were initiated, 14 with HT and 6 with CT. Of the 21 patients on CT, 14 (66.6%) were on adjuvant/neoadjuvant therapy. Of these, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte colony stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. The remaining 7 of 21 patients (33.3%) were on palliative CT. Of these, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one of them and this decision was due to the progression of the disease in the other patient). The 90 patients who were receiving adjuvant, neoadjuvant, or palliative criteria HT and/or anti-HER2 therapies, continued the treatment with no changes Conclusions: Although these are preliminary results, the available evidence suggests that, although medical appointments decreased by approximately 17%, the UDAM was able to maintain its healthcare activities and continued most of the treatments. The most modified treatment was CT, with the addition of prophylactic G-CSF, to avoid myelosuppression and potential complications from COVID-19 infection.