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IMPACT AND RECOVERY FROM COVID-19-RELATED DISRUPTIONS IN COLORECTAL CANCER SCREENING AND CARE: A SCENARIO ANALYSIS
Gastroenterology ; 162(7):S-159, 2022.
Article in English | EMBASE | ID: covidwho-1967249
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)
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Gastroenterology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Gastroenterology Year: 2022 Document Type: Article