# Colorectal cancer follow-up after surgical resection since the COVID-19 pandemic: first steps towards out-of-hospital follow-up?

## TL;DR

This study examines how the COVID-19 pandemic affected follow-up care for colorectal cancer patients in the Netherlands, showing a significant shift to out-of-hospital consultations.

## Contribution

The study provides the first population-based evidence of the rapid adoption of out-of-hospital follow-up for colorectal cancer patients during the pandemic.

## Key findings

- The percentage of out-of-hospital follow-up consultations rose from 23% to 80% in early 2020.
- Younger patients had a higher median number of follow-up consultations per year.
- The total number of follow-up consultations remained stable during the study period.

## Abstract

The COVID-19 pandemic impacted outpatient clinic services globally. It is unknown how the pandemic affected the follow-up of surgically treated colorectal cancer (CRC) patients. This population-based study aimed to assess the trends in CRC follow-up consultations before and during the COVID-19 pandemic in the Netherlands.

Nationwide health care activities data between January 2018 and July 2021 were merged with patient-level data from the Netherlands Cancer Registry of stage I-III CRC patients treated with surgical resection. The number of follow-up consultations per patient per year was calculated, and between-group differences were assessed with descriptive statistics. Trends in the number and setting of follow-up consultations were assessed using joinpoint regression analyses. Out-of-hospital follow-up was defined as written, telephone or video consultations.

In total, 42 970 CRC patients were included. The median number of follow-up consultations per year per patient was 2.9 (interquartile range: 2.0-4.7). The median number of follow-up consultations increased with disease stage (P < 0.001) and was higher for patients <60 years of age (P < 0.001). The total number of follow-up consultations did not change during the study period (P = 0.333). The percentage of out-of-hospital follow-up increased from 23% to 80% between January and April 2020 (P < 0.001), and remained between 48% and 59% until the end of the study period.

This population-based study showed a great increased use of out-of-hospital consultations during CRC follow-up, which predominantly corresponded to the severity of the COVID-19 pandemic. Future studies should assess whether the use of out-of-hospital follow-up consultations has persisted after the pandemic.

•Out-of-hospital follow-up after treatment of colorectal cancer is relatively new.•The COVID-19 pandemic has accelerated the development of out-of-hospital follow-up.•This cohort measured the start of out-of-hospital follow-up in the Netherlands.•The median number of follow-ups was higher for younger patients.

Out-of-hospital follow-up after treatment of colorectal cancer is relatively new.

The COVID-19 pandemic has accelerated the development of out-of-hospital follow-up.

This cohort measured the start of out-of-hospital follow-up in the Netherlands.

The median number of follow-ups was higher for younger patients.