ABSTRACT
Purpose: To assess the impact of the COVID-19 pandemic in England on diagnoses and treatments for colorectal cancer (CRC), and evaluate the variation in deficit of diagnoses and major resections by age and deprivation Methods: Rapid Cancer Registrations Data were used, linked to Hospital Episode Statistics, the Systemic Anti-Cancer Therapy Dataset and the National Radiotherapy Dataset. 33,814 patients newly diagnosed with CRC 1 January 2019 to 31 March 2021 were included Results: There was a large deficit in new CRC diagnoses and treatments early in the pandemic. There was still an 8.6% deficit in new CRC diagnoses by March 2021, a 17.6% deficit in major resections by end 2020, a 21.9% deficit in adjuvant chemotherapy by February 2021, but little deficit in curative radiotherapy for rectal cancer by March 2021. By March 2021 those just below and just above screening age had the largest deficits of new diagnoses. The most deprived patients had the largest deficit of diagnoses and major resections (20 to 21% deficit in major resections in the two most deprived quintiles compared to 16 to 17% in the other quintiles) Conclusion(s): Ongoing efforts to promote and raise awareness of bowel cancer signs and symptoms should continue to try to mitigate the delays in bowel cancer diagnoses during the pandemic, with particular focus on the most deprived and on those just below and just above screening age. Further work is needed to understand the reasons for the association between socioeconomic deprivation and deficit in diagnoses and major resections.
ABSTRACT
Aims: The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection. This study aimed to compare the management and outcomes of colorectal cancer (CRC) patients during the first two months of the COVID-19 pandemic with the preceding six months. Methods: A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between 1st October 2019 and 31st May 2020. Mortality of CRC resection was compared before and after 23rd March 2020 ('lockdown' start). Results: The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week) whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality was similar in 'cold' and 'hot' sites (P > 0.5 elective and emergency procedures). Conclusion: Surgical resection is the mainstay of treatment for non-metastatic CRC. The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge, and a substantial increase in post-operative mortality, concerning for patients with CRC and clinical services alike. This demonstrates the importance of maintaining CRC services and minimising the risk of peri-operative COVID-19 infection.
ABSTRACT
Aim: We studied how National Health Service hospitals in England and Wales aimed to maintain effective and safe colorectal cancer (CRC) services during the first peak of the COVID-19 pandemic period (April 2020). Methods: A mapping exercise was performed among all 148 hospitals providing CRC services. Information was collected about changes in referrals, diagnostic, staging and therapeutic procedures, as well as whether there was access to a 'cold site' (hospital facility free of COVID-19). Clinicians in each hospital were also asked to give the 'single most important lesson learned' about keeping services safe and effective. Results: Full responses were received from 123 (83%) hospitals and information about 'cold sites' was available for 146 (99%). 80 hospitals (54%) had access to a 'cold site' and this was increased in regions with higher COVID-19 infection rates (P = <0.001). Of the 123 responding hospitals, 105 (85%) indicated referrals of patients with suspected CRC had dropped by at least 30%, and 69 (56%) indicated that treatment plans were altered in at least 50% of CRC patients. However, 'cold site' availability protected capacity for diagnostic colonoscopy (P = 0.013) and CRC resection (P = 0.010). Many 'lessons learned' highlighted the importance of adequate structural service organisation, often mentioning 'cold sites' and regional coordination as examples, good communication, and triage of patients based on clinical urgency. Conclusion: Access to 'cold sites', as well as regional coordination, clear communication, and strong leadership, were found to be pivotal in maintaining diagnostic and treatment CRC capacity during COVID-19 surge.
ABSTRACT
Introduction: The COVID-19 pandemic has had a profound impact on cancer care. We evaluated the impact on the diagnosis and treatment of men with prostate cancer (PCa) in England. Patients/Methods: Patients diagnosed with PCa in the English NHS between 1st January 2019 and 30th June 2020 (N=58,749) were identified in the Rapid Cancer Registration dataset. Patient-level linkage to the Cancer Waiting Times dataset provided information on radical surgery and radiotherapy within 12 months of diagnosis. Follow-up was available to 31st July 2020. Changes in monthly diagnoses and treatments following the start of the UK lockdown on 23rd March 2020 were compared with the corresponding month in 2019. Results: Overall, there was a 56% reduction in diagnoses compared with 2019 (55% in April, 62% in May and 51% in June). Radical surgery also declined (by 61% in April, 60% in May) with a relatively greater reduction in radiotherapy (by 75% in April, 69% in May) compared with 2019. Radical treatment activity increased from June with a one third reduction compared with 2019 in radical surgery (34%) and radiotherapy (33%) by July. Conclusion: Diagnostic and radical treatment activity fell significantly following the UK lockdown. There was evidence of a recovery in surgical and radiotherapy activity in June although this was not complete by the end of July 2020. Follow-up to September 2020 and linkage to routine hospital datasets (HES, RTDS and SACT) will allow further exploration of treatment patterns and their recovery. These analyses will be completed by the time of presentation.