IMPACT OF COVID-19 ON PANDEMIC MAJOR GASTROENTEROLOGY PROCEDURES, VISITS, AND NEW DIAGNOSIS OF GASTROINTESTINAL CANCERS

ABSTRACT

Introduction: The COVID-19 pandemic has caused an extraordinary burden on the healthcare system and has dramatically impacted the delivery of health care services including endoscopy procedures and routine gastroenterology inpatient and ambulatory care. This has led to significant concerns that major gastrointestinal cancer diagnosis can be delayed as a consequence of this pandemic. We aimed to quantify the impact of the COVID-19 pandemic on the diagnoses of major GI cancers. Methods: Search queries were performed on the TriNetX platform to estimate the number of patient encounters, procedures, and diagnoses of new GI cancers per 100,000 patients at participating HCOs in the US between March 15, 2020, and July 15, 2020, and March 15, 2019, to July 15, 2019. Differences in the number of encounters, procedure volume, and new diagnoses before and during the pandemic are compared and reported as a percentage increase or decrease. Results: During the pandemic, major declines were seen in both the inpatient (13,334.50 vs. 22,256.57;%change -42.99% per HCO) and emergency department (21,933.06 vs.35,225.72;% change -40.09% per HCO) in comparison to the same interval in 2019. A relatively smaller decline was seen in the ambulatory visits (130,245.84 vs. 159,996.81;% change -22.55% per HCO) during the pandemic compared to 2019. A large increase in virtual or telehealth visits (7,266 vs. 14,612.67;% change +4465.02%) was seen during the pandemic compared to 2019. The volume of the upper endoscopies per 100,000 patients had a decline of 71.84% (52.47 per 100,000 vs. 186.38 per 100,000) with 2019. Similarly, a decline of 84.66% (46.02 per 100,000 vs. 299.95 per 100,000) was seen in the volume of colonoscopies during the pandemic compared with 2019. The number of right upper quadrant abdominal ultrasounds (344.74 vs. 536.79;% change = -35.78%) decreased during the pandemic in comparison to the same duration in 2019. The new diagnoses of the liver and intrahepatic cancers declined to almost one-third (34.13%) during the pandemic while the diagnoses of colorectal cancers decreased by 30.91 % as compared to the similar duration in 2019. We also noticed a decline in the number of new diagnoses in the esophageal and gastric cancers (26.96%) followed by pancreato-biliary cancers (-22.81%). Conclusion: Our study showed that the health care encounters and major GI procedures declined during the pandemic leading to a reduction of new diagnoses GI cancer cases among the patients who had health care encounters during the pandemic that could have led to missed opportunities for a new diagnosis of cancers. Delay in diagnosis during the COVID-19 pandemic could lead to an increase in late-stage cancer cases and poor cancer outcomes. Urgent policy and practice interventions are needed to address the consequences of delays in the diagnosis of these can-cers.(Table Presented)Number of patient encounters, endoscopic procedures and new diagnoses of major GI cancers per 100,000 patients with a percentage change before and during the pandemic.