Quantifying the impact of the COVID-19 pandemic on an anal squamous cell carcinoma and anal intraepithelial neoplasia cohort: A retrospective single centre cohort study

ABSTRACT

Aims: The COVID-19 pandemic has affected patient care worldwide. This study aimed to quantify this impact on a cohort with anal squamous cell carcinoma (ASCC) and anal intraepithelial neoplasia (AIN), a premalignant lesion for the former. Throughout the pandemic, remote consultations were utilised to reduce the risk of COVID-19 infection with face-to- face appointments and examination when potential problems were identified. Method(s) Retrospective data were extrapolated for all ASCC and AIN patients undergoing follow-up at a single centre within the COVID-19 period, from 01/03/2020 to 01/11/2021. Diagnostic biopsy delays for suspicious lesions were identified from patient records. Clinical follow-up was assessed against local guidelines of 6-monthly (+/-1 month) for high-grade AIN and ASCC and yearly (+/-2 months) follow-up for low-grade AIN to identify AIN progression and ASCC recurrence (defined as biopsy confirmation >6 months after initial diagnosis). Result(s) 124 patients with ASCC (n = 64) and AIN (n = 60) were identified. 93 (75%) experienced accurate follow-up as per guidelines. Within this period, three progressed from AIN to ASCC, and five had ASCC recurrence. 9 were diagnosed with ASCC and 15 with AIN. Of the 24 diagnostic biopsies performed, 3 (12.5%) were delayed, which diagnosed high-grade AIN. Five further biopsy delays beyond diagnosis were identified, just one of which diagnosed AIN progression to ASCC. Conclusion(s) The adjustment to remote consultation has maintained timely follow-up for the majority of patients with AIN. Despite minimising COVID-19 impact for this cohort, future follow-up is necessary to assess this comprehensively.