A Cohort Study Analysing the Impact of the COVID-19 Pandemic on Colorectal Cancer Presentations in a Medium-Large Canadian Community Hospital

TL;DR

This study examines how the COVID-19 pandemic affected colorectal cancer diagnoses in a Canadian hospital, finding fewer procedural screenings but stable symptom-based presentations.

Contribution

The study provides new insights into the impact of the pandemic on colorectal cancer screening and diagnosis patterns in a community hospital setting.

Findings

Procedural diagnoses decreased during the pandemic, while FIT testing remained stable.

Females and those with a family history were more likely to be diagnosed via screening.

Symptomatic presentations did not increase as expected during the pandemic.

Abstract

Colorectal Cancer (CrC) is a common cause of cancer-related death worldwide, but screening programs are highly effective at diagnosing early-stage disease, allowing effective treatment. During COVID-19, a decrease in screening participation was hypothesized due to limited access, leading to an increase in symptomatic presentations and stage at diagnosis.

All patients who met inclusion criteria were divided into two cohorts based on time of diagnosis (n = 373). The pre-COVID era was designated as December 2018 to February of 2020, with the COVID era running from then until March 2021. All patients were from the Windsor Regional Hospital Cancer Centre, located in Windsor, Canada.

Across time periods, 218 patients were diagnosed prior to, and only 144 during COVID. The number of Fecal Immunochemical Test (FIT) positive patients remained stable, while the number of procedural diagnoses decreased from 34.1% to 10.7%, with only 21.2% of patients overall being diagnosed with screening. When combining time periods, females presented symptomatically (85.0%) more often than males (74.4%). Patients with a positive family history were more likely to be diagnosed via procedural screening (42.9%) than those without (20.4%).

There was no change to the proportion of symptomatic presentations across time groups, in contrast to our predicted outcome. There was a decrease in procedural screening during the COVID timeframe, with FIT testing rates remaining stable, likely representing patients being transferred to available methods. Female patients and patients with a family history demonstrated a particular need for increased screening participation based on our findings.

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