# Colorectal cancer survivorship program at a single tertiary centre: has service provision changed after COVID-19?

## TL;DR

This study examined how colorectal cancer survivorship care changed in Victoria before and after the COVID-19 pandemic.

## Contribution

The study provides insights into the consistency of surveillance care for colorectal cancer patients during and after the pandemic.

## Key findings

- Stage III patients had the highest surveillance uptake, while Stage I patients had the lowest.
- Colonoscopy surveillance rates were low across all stages.
- More patients had 12-month CT scans post-pandemic compared to pre-pandemic.

## Abstract

Surveillance after colorectal cancer (CRC) resection is an important aspect of survivorship care. This study aimed to assess whether there were any changes to post-operative surveillance uptake in non-metastatic CRC patients and pre- and post-COVID pandemic in Victoria.

All CRC patients (Stages I–III) who underwent curative surgery at Western Health, Victoria, Australia, were included. Surveillance included a three-monthly clinical review and carcinoembryonic antigen (CEA) up to 18 months and CT imaging and colonoscopy at 12 months following surgical resection.

Between 2019 and 2022, 380 patients were identified. Stage III patients had the highest uptake with regard to clinical reviews, CEA testing and 12-month CT (83.3%, 60.3% and 85.5%, respectively) while Stage I patients had the lowest (52.7%, 35.7% and 75.5% respectively) (p < 0.05). Colonoscopy surveillance was low regardless of stage (66.3%, 59.8% and 59.7% of Stages I, II and III, respectively). Uptake of CEA, clinic reviews and colonoscopy did not vary during our study period. More patients underwent 12-month CT following the COVID pandemic (87%) compared to pre-COVID (73.1%) or during COVID (76%, p < 0.05). There was no difference in 18-month mortality and overall recurrence during our study timelines.

Lower-stage CRC patients had lower rates of surveillance uptake, in particular, with CEA blood tests and colonoscopy. Survivorship provision did not change pre- or post-COVID.