Has the COVID-19 pandemic lead to an upshift in emergency presentation and stage migration of colorectal cancer in Uruguay?

ABSTRACT

Background: Effective Cancer screening is critical in reducing cancer related mortality in CRC by increasing the detection in earlier stages. Worldwide, practically all cancer pathways have been negatively affected by the implications of the COVID-19 pandemic. Oncological care has not escaped the effects of reprioritization of health care services to handle the surge of COVID-19 patients adequately. Cancer screening programs are no exception as many were temporarily halted to alleviate the pressure on overwhelmed health care systems. In Uruguay, the first covid patients were detected in March 2020, and since then, the country's Public Health policies have been marked by the covid-19 public health emergency. The aim of this study is to assess the impact of the COVID-19 pandemic on CRC diagnosis. We further aimed to analyze the effect on the clinical presentation and stage at diagnosis during 2020-2021 compared with previous years. Methods: This was a retrospective cohort study performed at a single tertiary center. Patients diagnosed and managed with colorectal adenocarcinoma during the years 2020-2021 were compared with patients from 2018-2019. Those enrolled in 2018- 2019 were classified as the “pre-pandemic group”, and those enrolled in 2020-2021 were classified as the “pandemic group”. The primary outcome was the rate of stage IV disease at the time of diagnosis. Mann-Whitney test was used in the comparison of quantitative variables and Fisher's exact test was used for qualitative variables. Results: A total of 370 patients were included in this study. From March 2018 to 2019 (pre-pandemic), 217 patients were considered, and from March 2020 to 2021 (pandemic), 153 patients. Median age of pre-pandemic and pandemic group was 64.4 and 65.6 years, respectively. There was no statistically significant difference in cancer obstruction or perforation at diagnosis. Patient demographics and tumor clinicopathological features were comparable. The percentage of surgical candidates was lower during the pandemic (69% vs 62%). There was a significant difference in TNM tumor distribution between pre-pandemic and pandemic subgroups with a higher incidence of advanced (cT4 or cN+ or M1) tumors. T4 tumors and node positive disease were equivalent in both groups but the incidence of disseminated disease (cM1) was significantly higher in the pandemic group (P < 0.001). Conclusions: Our study demonstrates how cancer diagnostic variables, mainly stage at diagnosis, have been affected by the impact of the COVID-19 pandemic on cancer screening programs. Therefore, it is of utmost importance that cancer diagnosis and treatment pathways be reinstalled in full to return to and build on pre-pandemic priority to ensure the benefits from earlier diagnosis and treatment. Future studies are needed to verify the tendency in stage migration and to optimize CRC care in the pandemic scenario.