Rectal cancer presentation and screening rates during the COVID-19 pandemic

1. Despite the decrease in colonoscopies performed at the start of the COVID-19 pandemic, there was no difference in the percentage of colorectal cancer (CRC) presentations at a later stage or with higher acuity, when comparing patients diagnosed with rectal adenocarcinoma pre-pandemic and during the pandemic.

Evidence Rating Level: 2 (Good)

Colonoscopies as part of colorectal cancer (CRC) screening are instrumental in the early diagnosis of CRC, and have been associated with a 75% reduction in mortality for those diagnosed with left-sided colon cancer, likely due to earlier detection. However, during the initial months of the COVID-19 pandemic, there were cancellations of non-urgent procedures, resulting in a 90% relative reduction in scopes performed in the US and England in April 2020. Therefore, this retrospective study aimed to determine if the cancellations from the COVID-19 led to more acute presentations of rectal adenocarcinoma, or presentations at a later stage, in comparison to pre-pandemic times. The study population included all patients diagnosed with rectal adenocarcinoma between 2016 and 2021 at a single centre. Pre-COVID patients were defined as a diagnosis made before March 1, 2020. With regards to outcomes, an acute presentation was defined as a visit to the emergency department or admission to hospital with symptoms related to rectal cancer. In total, there were 208 patients included, 163 of which comprised the pre-COVID cohort. The results showed that the stage at presentation was similar, with the majority presenting with stage III (40.0% pre-COVID vs 33.3% COVID, p = 0.26). The rate of patients bleeding as the presenting complaint or presenting after CRC screening were similar as well (50.3% pre-COVID vs 42.2% COVID for bleeding, and 24.5% pre-COVID vs 24.4% for COVID respectively). Following adjustment for covariates, there was still no difference in acute presentation between the pre-COVID and COVID cohorts (odds ratio 1.24, 95% CI 0.57-2.72, p = 0.59). Overall, this study demonstrated that despite a decrease in CRC screening at the start of the COVID-19 pandemic, there was no increased proportion of acute CRC presentations or later stage, compared to pre-pandemic times.

Click to read the study in PLOSONE

Image: PD

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