ABSTRACT
Introduction: Many countries were forced to temporarily suspend their cancer screening programme due to the COVID-19 pandemic;in the Netherlands, the colorectal cancer (CRC) screening programme was suspended for two months in 2020 (1-3). To clear the backlog after restarting, it was decided to delay the invitation interval from 24 months up to a maximum of 30 months (4). This study assessed the individual impact of the extended invitation interval due to COVID-19 pandemic on the key performance indicators of the Dutch CRC screening programme. Aims & Methods: All participants eligible for FIT screening in 2019 and 2020 were included in the study. Individual-level data were retrieved from the national information system (ScreenIT) for CRC screening. Multivariable logistic regression analyses were used to assess the association between either the different time periods (before, during,orafterthe first COVID-19 wave) or the invitation interval on the key performance indicators (i.e. participation FIT and follow-up colonoscopy, FIT positivity, positive predicted value (PPV) and FIT interval cancers), adjusted for confounding factors age, sex and invitation round. Result(s): FIT and follow-up colonoscopy participation were lower duringthe first COVID-19 wave, both for the first (OR: 0.80, 95%CI: 0.78-0.82)) and subsequent invitation rounds (OR: 0.73, 95%CI: 0.72-0.74). FIT positivity was slightly higher during,but for first-round participants only (OR: 1.04, 95%CI: 0.97-1.12). PPV for CRC and advanced neoplasia (AN) was lower during and after the first COVID-19 wave for the first (OR: 0.85, 95%CI: 0.71-0.98 and OR: 0.92, 95%CI: 0.85-0.98) and subsequent invitation rounds (OR: 0.95, 95%CI: 0.86-0.96 and OR: 0.95, 95%CI: 0.92-0.98). Models including invitation interval, showed higher participation for FIT and follow-up colonoscopy with extended invitation intervals >26 months. No relevant differences were observed for FIT positivity, PPV for CRC and AN, and interval cancers for the different invitation intervals. Conclusion(s): The impact of the first COVID-19 wave as well as the associated extended invitation interval on the key performance indicators was small, with the highest negative impact on participation rates in the first screening round during and after the first wave. In case of future unexpected bottlenecks, emphasizes might be placed on invitation strategies and public awareness for CRC screening, especially for first screening round invitees.
ABSTRACT
Objectives Colorectal cancer (CRC)-related services decreased substantially as a result of the COVID-19 pandemic. Large numbers of procedures were suspended and many have not yet been completed. Resulting delays in cancer screening and diagnosis may negatively impact CRC outcomes. In this study, we predict this impact, and compare different recovery scenarios in the United States. Methods The MISCAN-Colon model was used to simulate the US population in 2020, and evaluate different impact and recovery scenarios. Scenarios were defined in terms of the duration and severity of the disruption (% of eligible adults affected), the length of delays, and the duration of the recovery. In the base-case analysis, we considered a 12-month disruption period, starting in March 2020. During this period, part of preventive and diagnostic procedures were cancelled and delayed. The severity of disruption by month was based on published literature (Embase and Ovid Medline, through December 21, 2020). The assumed delays in services followed a discrete-time distribution, which was a function of the severity of disruption. During recovery, colonoscopy capacity was increased to catch up missed procedures, over a period of 6, 12, or 24 months. In sensitivity analyses, we varied the disruption period (6-18 months) and severity of disruption (lower/higher). Primary outcomes were excess CRC cases and deaths, required excess colonoscopy capacity during recovery, and additional number-needed-to-scope during recovery to prevent one death. Results The COVID-19 pandemic reduced preventive colonoscopies by an estimated 30% in 2020, and overall colonoscopies by 25%. For a 24-month recovery period, the model predicted 8,010 (0.21%) excess CRC cases during 2020-2040, 7,370 (0.69%) excess CRC deaths (Figure 1), and required 103,900 (8.3%) excess colonoscopies per recovery month (Table 1). Shorter recovery periods decreased long-term excess CRC cases to 5,540 and 2,740, for 12 and 6 months, respectively and excess deaths to 5,150 and 4,820. However, this reduction in excess cases came at a cost of 254,600 and 579,600 excess colonoscopies per month. The prevention of the excess CRC deaths through the shorter recovery periods of 6 or 12 months required an additional 1,150 and 840 colonoscopies per excess death prevented compared to the 24-month recovery. In sensitivity analysis, the predicted overall impact varied between 1,930-12,630 deaths, and 83,600-887,700 colonoscopies (Table 1). Conclusions Delayed cancer-related services due the pandemic will likely cause thousands of CRC cases and deaths in the next 20 years. The impact could be limited if the backlog were cleared within 6 or 12 months vs. 24 months. However, additional endoscopy capacity needs should be balanced against competing medical interests. Keywords: COVID-19, Colorectal cancer, screening, diagnosis (Figure Presented) (Table Presented)
ABSTRACT
Background Colorectal cancer (CRC) screening programs worldwide have been disruptedduring the COVID-19 pandemic. CRC screening has been well-established to reduce longtermCRC incidence and mortality. Any disruption to screening would reduce these healthbenefits. This study aimed to estimate the impact of hypothetical disruptions to organizedCRC screening programs on short and long-term CRC incidence and mortality in threecountries using microsimulation modelling.Methods Using well-calibrated and validated CRC microsimulation models for Australia(Policy1-Bowel), Canada (OncoSim) and the Netherlands (ASCCA and MISCAN-Colon)participating in the COVID-19 and Cancer Global Modelling Consortium (CCGMC), wesimulated a range of hypothetical scenarios to assess the potential impact of disruptions toscreening on CRC incidence and mortality. All models simulate the adenoma-carcinomapathway, and ASCCA and Policy1-Bowel additionally simulate the serrated pathway. Modelledscenarios varied by disruption duration (3-, 6 and 12-months), post-disruption participationreduction (3-months -50% and 3-months -25%, and 6-months -50%), and catchupscreening strategies (no catch-up, immediate, and 6-months delayed catch-up).Results Without catch-up screening, CRC incidence would increase by 0.1-0.3%, 0.2-0.6%,and 0.4-1.2% over 2020-2050 among individuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions, respectively (Figure 1). CRCmortality would increase by 0.2-0.5%, 0.4-1.0%, and 0.8-2.0% over 2020-2050 amongindividuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions, respectively, compared to undisrupted screening (Figure 2). A 6-monthdisruption without catch-up would result in an estimated 3,552, 2,844 and 803-1,803additional CRC diagnoses and an estimated 1,964, 1,319, and 676-856 additional CRCrelateddeaths in Australia, Canada and the Netherlands, respectively, compared to undisruptedscreening. A post-disruption reduction in participation could increase CRC diagnosesby 0.2-0.9% and CRC-related deaths by 0.5-1.6% compared to undisrupted screeningdepending on the size of the reduction in participation. Providing catch-up could minimizethe impact of the disruption to an increase of 0.0-0.2% in CRC diagnoses and CRCrelateddeaths.Conclusion Although the relative impact of the modelled CRC screening disruptions (whenconsidered over the long-term, 30 years) due to the COVID-19 pandemic appears modest,given a high burden of CRC, there is a substantial impact on CRC diagnoses and deathsacross all countries considered. It is crucial that, if disrupted, screening programs ensureparticipation rates return to previously observed rates and provide catch-up screening whereverpossible, as the impact of any disruption could be considerably larger otherwise.(Image Presented)Change in CRC incidence relative to the comparator scenario (no disruption) by MISCANColon,ASCCA, Policy1-Bowel and OncoSim Abbreviations: CRC, Colorectal Cancer. Note:the base case scenario is the scenario in which a 6-month disruption period from Aprilto September 2020 was assumed, with no catch-up or changes to participation in therecovery period.(Image Presented)Change in CRC mortality relative to the comparator scenario by MISCAN-Colon, ASCCA,Policy1-Bowel and OncoSim Abbreviations: CRC, Colorectal Cancer. Note: the base casescenario is the scenario in which a 6-month disruption period from April to September2020 was assumed, with no catch-up or changes to participation in the recovery period.
ABSTRACT
Background During the first wave of the COVID-19 pandemic, many colorectal cancer (CRC) screening programs worldwide were disrupted. At restart of screening programs, the backlog is to be caught up while at the same time the regular invitations are to be sent out, straining colonoscopy capacity. At this time, our country is hit by a second wave of the pandemic, forcing many health care providers to downscale their services again. In this study, we assessed the best method to deal with these temporary shortages in colonoscopy capacity in the Dutch FIT-based CRC screening program while retaining optimal preventive effect of the screening program. Methods Using the well-calibrated and validated MIcrosimulation SCreening ANalysis for CRC model (MISCAN-Colon), we simulated the Dutch national CRC screening program in which individuals are biennially invited to perform a faecal immunochemical test (FIT) from age 55-75, including the three-month disruption of the program in the first half of 2020. For the second half of 2020 and 2021, we simulated three different interventions to temporarily reduce the required colonoscopy capacity in the Dutch national CRC screening program: 1) increase in FIT cut-off value (from 47 to 50, 55, 60, 70 μg Hb/g feces), 2) excluding specific age-groups for screening (youngest age-group (age 55) or age-groups testing negative in previous two screening rounds (age 63 and/or 65), and 3) extension of the screening interval (from 24 to 28, 30, 32, 34 or 36 months). For each scenario, we estimated the impact on required colonoscopy capacity in 2020-2021 as well as long-term outcomes such as CRC incidence, mortality and life years (LYs) lost. Outcomes were compared to a reference scenario without colonoscopy restrictions. Results In 2020 and 2021, the required colonoscopy capacity without restrictions was 100,300 colonoscopies in total. Increasing the cut-off, excluding age-groups and extending the screening interval resulted in a reduction of 11,600-27,000 (11.6% - 26.9%), 10,800-27,000 (10.8% - 26.9%) colonoscopies, and 16,100-49,500 (16.1% - 49.4%) colonoscopies, respectively (Table 1). Increasing the cut-off resulted in 400-900 excess CRC cases and 200-500 excess CRC-related deaths from 2020-2050, while excluding age-groups resulted in 200-600 excess CRC cases and 200-500 excess CRC-related deaths. Unexpectedly, extending the screening interval up to 34 months prevented 200-300 more CRC cases and 200-600 more CRC-related deaths, because screening occurred until slightly higher ages due to the initial delay. All measures resulted in LYs lost, but extending the screening interval up to 34 months had the smallest impact. Conclusion Based on modeling, temporarily extending the screening interval to accommodate reduced colonoscopy capacity due to the COVIDpandemic have the smallest impact on the CRC incidence, mortality and LYs lost. (Table Presented) The efficiency of measures to reduce colonoscopy demand predicted by MISCANColon. Abbreviations: CRC, colorectal cancer;LYs, Life Years;μg Hb/g feces, microgram Hemoglobin per gram feces.
ABSTRACT
Aims A second wave of the COVID-19 pandemic may force many health care providers to downscale their services again,including colonoscopies which may impact capacity for colorectal cancer (CRC) screening. This study aimed to determinethe optimal measure to handle these temporary shortages in colonoscopy capacity in the Dutch national CRC screeningprogram to retain as much of the preventive effect of the screening program as possible. Methods We used the MISCAN-Colon model to simulate the Dutch national CRC screening program, providing biennial FITto individuals aged 55-75, under three different scenarios to temporarily reduce required colonoscopy capacity in thesecond half of 2020 and 2021: increase in FIT cut-off value exclusion of specific age-groups, and extension of the screening interval For each scenario, we estimated the impact on required colonoscopy capacity in 2020-2021, long-term CRC incidence,mortality and life years (LYs) lost. Outcomes were compared to a reference scenario without colonoscopy restrictions. Results In 2020 and 2021, the required colonoscopy capacity without any restrictions was 100,300 colonoscopies.Increasing the cut-off, excluding age-groups and extending the screening interval resulted in a reduction of 11,600-27,000,10,800-17,500, and 16,100-49,500 colonoscopies, respectively (Table 1). Increasing the cut-off resulted in 400-900 excessCRC cases and 200-500 excess CRC-related deaths from 2020-2050, while excluding age-groups resulted in 200-600excess CRC cases and 200-500 excess CRC-related deaths. Unexpectedly, extending the screening interval up to 34 months prevented 200-300 more CRC cases and 200-600 more CRC-related deaths, because screening occurred until slightlyhigher ages due to the initial delay. All measures resulted in LYs lost, but extending the screening interval up to 34 monthshad the smallest impact. Abbreviations: CRC, colorectal cancer;LYs, Life Years;μg Hb/g feces, microgram Hemoglobin per gram feces.∗Number between brackets are negative numbers. Conclusions A temporary extension of the screening interval to accommodate reduction in available colonoscopy capacityresults in the smallest impact on the CRC incidence, mortality and LYs lost. (Table Presented).
ABSTRACT
Aims Colorectal cancer (CRC) screening programs worldwide have been disrupted during the COVID-19 pandemic. Thisstudy aimed to estimate the impact of hypothetical disruptions to organized FIT-based CRC screening programs on short-and long-term CRC incidence and mortality in three countries using microsimulation modelling. Methods Using CRC microsimulation models for Australia (Policy1-Bowel), Canada (OncoSim) and the Netherlands (ASCCAand MISCAN-Colon) participating in the COVID-19 and Cancer Global Modelling Consortium (CCGMC), we simulated a rangeof scenarios to assess the potential impact of disruptions to screening on CRC incidence and mortality. Modelled scenariosvaried by disruption duration (3-, 6-and 12-months), post-disruption participation reduction, and catch-up screeningstrategy (no catch-up, immediate and 6-month delayed catch-up). Results Without catch-up screening, CRC incidence increased by 0.1-0.3 %, 0.2-0.6 %, and 0.4-1.2 % over 2020-2050among individuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions,respectively, compared to undisrupted screening and CRC mortality increased by 0.2-0.5 %, 0.4-1.0 %, and 0.8-2.0 % over2020-2050 among individuals aged 50 years and older compared to undisrupted screening. A 6-month disruption withoutcatch-up resulted in an estimated 3,552, 2,844 and 803-1,803 additional CRC diagnoses and 1,961, 1,319, and 678-881 additional CRC-related deaths in Australia, Canada and the Netherlands, respectively. A post-disruption reduction inparticipation increased CRC diagnoses by 0.2-0.9 % and CRC-related deaths by 0.5-1.6 % compared to undisruptedscreening. Providing catch-up screening minimized this impact to 0.0-0.2 %. Conclusions Although the relative impact of the modelled CRC screening disruptions due to the COVID-19 pandemicappears modest, given a high burden of CRC, there is a substantial impact on CRC diagnoses and deaths across allcountries considered. It is crucial that, if disrupted, screening programs ensure participation rates return to previouslyobserved rates and provide catch-up screening wherever possible, as the impact of any disruption could be considerablylarger otherwise.