COVID-19 impact on colorectal cancer care in 2020: Preliminary data from the Italian COVID-DELAY study

ABSTRACT

Background: Since March 2020, Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide causing a massive Health Care crisis with Italy among the most affected countries. Oncology care has been widely derailed and cancer screening programs halted to effectively face the pandemic. Aim of our multicenter study is to assess how COVID-19 has impacted on the likelihood of receiving timely diagnosis, staging and treatment for colorectal cancer (CRC) patients (pts) during the 2020 compared to pre-pandemic period. Material (patients) and methods: All consecutive medical records of newly diagnosed CRC pts referred to 4 Italian Oncology Departments between March and December 2020 were evaluated. Monthly access rate and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019. Differences between the two years were evaluated using Fisher's exact or chisquare test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: A considerable drop (20%) in newly diagnosed CRC cases emerged compared to 2019 (214 vs 268). The lockdown period was more impacted by such decrease compared to the other months (percentage drop 40% vs 12%). New CRC diagnoses in 2020 were less likely to be diagnosed with early stage (stage I-II-III) CRC (67% vs 72%). Other clinical and tumor characteristics such as age, gender, sidedness and mutational status were similar regardless of the year. Looking at pts management, no differences were seen in terms of interval between symptom onset and radiological diagnosis (median 19 days in 2020 vs 28 days in 2019, p=0.88), symptom onset and cytohistological diagnosis (25 vs 36 days, p=0.27), symptom onset and treatment start (median 86 vs 100 days, p=0.79). However, less CRC were discussed in multidisciplinary tumor meetings during the 2020 (45% vs 54%, p=0.07). Conclusions: While COVID-19 effects on cancer pts' outcome might unfold in the years to come, our preliminary data show a remarkable drop in early stage CRC diagnoses throughout 2020. The Italian Oncology Departments managed to optimally tackle the quality care issue ensuring prompt diagnosis and treatment despite the pandemic evolving scenario. Further investigation, including larger case series, are warranted to offer a more exhaustive picture of the impact of COVID-19 emergency on cancer care.