ABSTRACT
Background: Colorectal cancer (CCR) is the third most common and the second most deadly cancer with 1.9 million new diagnoses worldwide in 2020. COVID-19 pandemic placed an unprecedented burden on health systems worldwide, directly impacting cancer patients’ management. Health-care systems reorganization led to a decrease on all non-urgent surgical and medical procedures, delaying cancer screening protocols. This study aims to access the impact of COVID-19 on Colorectal Cancer management in a Portuguese Oncology Department. Methods: A retrospective cohort study comparing the new colorectal cancer diagnosis between March/2019 and March/2022. New diagnosis between March/2019 and March/2020 were assigned to Cohort 1 “Before COVID-19 Pandemic” and new diagnosis between March/2020 and March/2022 assigned to Cohort 2 “During COVID-19 Pandemic”. Data was collected from digital medical records and statistical analysis performed using SPSS V.25 IBM®. Results: Between March/19 and March/22 were diagnosed 313 new colorectal cancers, 116 (37%) assigned to Cohort 1 “Before COVID-19 Pandemic” and 197 (63%) to Cohort 2 “During COVID-19 Pandemic”. Analysing the new diagnosis in Cohort 2, 105 (34%) occurred between March/20-21 and 92 (29%) between March/21-22. Mean age at diagnosis of 69 (30-96) years for Cohort 1 and 68 (32-94) years for Cohort 2. 42% (n=49) females and 58% (n=68) males in Cohort 1 compared to 38% (n=77) females and 62% (n=123) males in Cohort 2. Colorectal cancer screening diagnosed 36% (n=42) patients in Cohort 1 and 35% (n=69) in Cohort 2. Clinical presentation with bowel obstruction was seen in 25% (n=29) in Cohort 1 and 37% (n=74) in Cohort 2 (p=0.02). Metastatic disease at diagnosis in 13% (n=14) for Cohort 1 and 26% (n=52) for Cohort 2 (p=0.07). Regarding management, 39% (n=46) underwent adjuvant systemic treatment in Cohort 1 compared to 28% (n=55) in Cohort 2 (p=0.03). Palliative systemic treatment was agreed for 7% (n=10) in Cohort 1 and 17% (n=36) in Cohort 2 (p=0.02). At diagnosis, best supportive care was decided for 2% (n=2) in the first Cohort and 15% (n=30) (p=0.03). Overall survival of 25 (1-36) months for Cohort 1 and 10 (1-23) months for Cohort 2. Conclusions: Comparison between pre-pandemic and in-pandemic periods revealed a numeric reduction on new cases of colorectal cancer in each 12 months period. Despite similar rate of diagnosis by colorectal cancer screening, statistical significance was found when comparing clinical presentation with bowel obstruction or metastatic disease. Despite that, less patients underwent adjuvant systemic treatment in cohort 2 and more were evaluated for best supportive care at diagnosis. These findings may be explained by more advanced disease in more fragile patients in the Cohort 2 population. The results of our study contribute to the evidence on the impact of COVID-19 pandemics on colorectal cancer with fewer diagnosis, more advanced disease, and lack of re-establishment of pre-pandemic rate of new diagnosis. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.
ABSTRACT
Background: On March 11, 2020, COVID-19 was declared a global pandemic. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this infection may remain asymptomatic. The European Society of Medical Oncology and the Portuguese Health Authority recommended both a symptomatic survey and laboratory testing in all cancer patients (pts) undergoing immunosuppressive treatment (IT). The impact of this measure is still unknown. We report our experience in a Portuguese center. Methods: Since March 2020, a symptomatic survey has been performed at our institution before each hospital visit. From April 6 through May 8, 2020, reverse-transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 testing was added on cancer pts before undergoing IT. The impact of this intervention was evaluated comparing the hospitalization rate of cancer pts due to COVID-19, before and after the introduction of RT-PCR testing. Retrospective analysis of clinical data was performed. Results: 444 tests were carried out on 244 pts and laboratory SARS-CoV-2 infection was confirmed in 11 (5%);5 were male, with a median age of 65 years [34-76]. Breast and colorectal cancer were prevalent;2 pts had lung cancer;6 advanced disease. Ongoing IT in these pts was temporarily suspended: 9 pts under chemotherapy, 1 atezolizumab and 1 rituximab. Only 1 patient was symptomatic (9%) and previously hospitalized. No admission due to COVID-19 was registered in this group. Since March 7, 179 pts were admitted due to COVID-19 at our center: 12 were active cancer pts (6.7%) of which 4 were under IT. 6 of the oncological pts passed away, all of them had advanced diseases, 1 was under IT. Of the dead pts, lung and breast tumors were prevalent. Among all COVID-19 hospitalizations, the prevalence of pts under IT was similar before and after the implementation of the RT-PCR testing (2.2% vs. 2.4%). Conclusions: We found a significant percentage of active cancer pts diagnosed with asymptomatic COVID-19. Due to the small sample size of COVID-19 pts under IT, it is difficult to evaluate the impact of RT-PCR testing. However, on a long-term analysis, this intervention may reduce the risk of severe complications related to COVID-19 in cancer pts. Health education and dynamic organization are also important measures. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.