Impact of the COVID-19 pandemic in colorectal cancer diagnosis and presentation

Exploring the feasibility of home-delivered capsule endoscopy with 5G support: innovations and carbon footprint insights

INTRODUCTION

Colorectal cancer (CRC) poses a significant global health threat, necessitating early detection. Traditional diagnostic tools like optical colonoscopy have limitations prompting our '5G-SUCCEEDS' initiative to explore a novel approach involving remote colon capsule endoscopy (CCE).

METHODS

This prospective feasibility study was conducted at a single hospital in England. Between December 2022 and September 2023, we introduced a remote CCE service within the 5G-SUCCEEDS framework. We undertook a feasibility study of CCE in patients with low-risk/moderate-risk CRC stratified by faecal haemoglobin. Outcomes included carbon footprint analysis (outlined through three potential clinical pathways) and patient-reported outcomes through structured questionnaires and interviews.

RESULTS

Among 25 participants, 88% expressed satisfaction with remote CCE. 82% were willing to have remote CCE if clinically indicated in future. CCE findings included adenomatous polyps (58%), normal results (17%) and diverticulosis (21%), with no cancers identified in this pilot. Notably, we found that the carbon footprint associated with delivery of CCE at home (pathway 3) was lower compared with CCE delivered in a clinical setting (pathway 2). A fully optimised, automated scaled-up pathway would combine the delivery and collection of CCE equipment within a local area to reduce the carbon footprint of the travel element by 75%. Moreover, the conversion rate into a colonoscopy pathway is not static and clinicians acknowledge that this could be as low as 28%. Carbon footprint is more favourable for home-delivered CCE in the optimised scenario, while less so when considering the need for additional procedures (colonoscopy conversion).

CONCLUSION

The 5G-SUCCEEDS initiative highlights the feasibility and advantages of home-based diagnostics using CCE.

Influence of the COVID-19 Pandemic on Patients with Rectal Cancer

Objectives: The COVID-19 pandemic and its associated restrictions have resulted in delayed diagnoses across various tumor entities, including rectal cancer. Our hypothesis was based on the expectation of a reduced number of primary operations due to higher tumor stages compared to the control group. Methods: In a single-center retrospective study conducted from 1 March 2018 to 1 March 2022, we analyzed 120 patients with an initial diagnosis of rectal cancer. Among them, 65 patients were part of the control group (pre-COVID-19), while 55 patients were included in the study group (during the COVID-19 pandemic). We compared tumor stages, treatment methods, and complications, presenting data as absolute numbers or mean values. Results: Fewer primary tumor resections during the COVID-19 pandemic (p = 0.010), as well as a significantly lower overall number of tumor resections (p = 0.025) were seen compared to the control group. Twenty percent of patients in the COVID-19 group received their diagnosis during lockdown periods. These patients presented significantly higher tumor stages (T4b: 27.3% vs. 6.2%, p = 0.025) compared to the control group prior to the pandemic. In addition, more patients with angiolymphatic invasion (ALI) were identified in the COVID-19 group following neoadjuvant treatment compared to the control group (p = 0.027). No differences were noted between the groups regarding complications, stoma placement, or conversion rates. Conclusions: The COVID-19 pandemic, particularly during lockdown, appears to have contributed to delayed diagnoses, resulting in higher tumor stages and a decreased number of surgeries. The quality of rectal cancer treatment can be maintained under pandemic conditions.

The impact of the COVID-19 pandemic on incidence gap in screen-detectable cancers: a cohort study in Greater Poland, Poland

Background

The global COVID-19 pandemic has had a significant impact on healthcare systems. This study aimed to assess the incidence gap in screening-detectable cancers in the Greater Poland (Poland) in 2020.

Materials and methods

Data on breast, cervix uteri, and colorectal cancer cases diagnosed from 2010 to 2020 were obtained from the regional cancer registry. Standardized incidence ratios (SIR) and incidence rate differences (IRD) were calculated to estimate the change in incident cancer cases during the pandemic. The number of observed cases was extracted from the registry database. Simple linear regression analysis was used to predict the expected number of incident cancer cases in 2020 and the age-standardized incidence rate based on registry data from the preceding ten years (2010-2019).

Results

In 2020, the registered number of incident female breast cancer cases decreased by 12% [SIR 0.88, 95% confidence interval (CI): 0.88-0.92, observed: 1,848, expected: 2,101], resulting in an IRD of -6.3 per 100 K. The number of registered cervical cancers decreased by 15% (SIR 0.85, 95% CI: 0.73-0.98, observed: 181, expected: 213), with an IRD of -0.8 per 100 K. For colorectal cancer, there was a 16% decrease in new cases among females (SIR 0.84, 95% CI: 0.78-0.90) and a 15% decrease among males (SIR 0.85, 95% CI: 0.80-0.91), resulting in IRDs of -3.04 and -5.29 per 100K, respectively.

Conclusions

The COVID-19 pandemic led to a significant, 15% decrease in newly diagnosed screening-detectable cancer cases in 2020. Further studies are needed to investigate the impact of delayed cancer diagnoses on stage at diagnosis and survival rates.

Age-related trends in colorectal cancer diagnosis: focus on evaluation of prehabilitation and rehabilitation programs

Abstract: The increase in the prevalence of both colon and rectal cancer in recent years poses challenges for the medical system in terms of patient management and indirectly incurs significant financial burdens. Purpose: The aim of this paper is to track the changes in the prevalance of the colon and rectal cancer at a tertiary clinic in Romania over time and to identify complementary methods to improve the prognosis and quality of life of cancer patients. Material and methods: We conducted an observational, longitudinal, population-based study, including all patients newly diagnosed with colon or rectal neoplasia within the time frame from 1 January 2013 to 1 January 2024 in a tertiary medical clinic in Romania. For each case included in the study, we gathered demographic data (age at the time of cancer diagnosis, gender, place of origin), location of the tumor, duration until surgical intervention, alternative treatment methods employed (such as ra-diation or chemotherapy, and immunotherapy), and the length of survival. We also assess the feasiblity of physical prehabilitation and rehabilitation programs for inpatients diagnosed with malignant neoplasms of the colon or rectum. Results: The study found significant differences in patient ages and the execution of prehabilitation and rehabilitation practices between those ad-mitted for colon and rectal cancer during the periods 2013-2018 and 2019-2023, with a notable shift in the prevalence of colon versus rectal cancer over these periods. Conclusions: Prehabilitation and rehabilitation practices for colorectal cancer patients are underdocumented or suboptimal, with recent improvements in documentation, especially for rectal cancer due to colostomy needs, and an observed increase in patient age due to COVID-19 pandemic protocols. Additional research and the development of standardized protocols are needed.

Impact of the COVID-19 pandemic on cancer screenings in Portugal

OBJECTIVES

This study aimed to evaluate the impact of the COVID-19 pandemic on cancer screening in Portugal, and its consequences on cancer morbidity and mortality.

METHODS

The pre-pandemic and pandemic periods were compared using publicly available data on performance and health outcomes indicators of the Portuguese NHS, namely the numbers and proportions of eligible individuals who underwent cancer screening (breast, cervical or colorectal). Pre-pandemic data were modelled to project hypothetical scenarios without a pandemic using an exponential smoothing algorithm, and then compared with data collected during the COVID-19 pandemic. A Markov model was developed to estimate years of life lost (YLL) due the reduction in the number of cancer screenings during the pandemic. The MS Excel and the PRISM symbolic model checker software were used.

RESULTS

There was a decrease in the number of breast (13 %), cervical (15 %) and colorectal (9-11 %) cancers screenings during the first two years of the pandemic. The model projections are 506, 41, and 148 additional deaths, losses of 11, 6, and 4 months of life per patient, and 12.8 thousand, 576, and 4 thousand YLL by the population due to breast, cervical, and colorectal cancer, respectively, over a 25-year time horizon in Portugal.

CONCLUSIONS

The disruption in cancer screening may contribute to increase cancer morbidity and mortality, with significant YLL. The long-term implications of the impaired cancer screening should be assessed, and proactive measures put in place to mitigate the increase in cancer morbidity, and mortality associated with the COVID-19 pandemic.

Decrease in the number of new cancer diagnoses during the first year of the COVID-19 pandemic - cohort study of 3.5 million individuals in western Poland

Introduction

The COVID-19 pandemic has considerably affected healthcare systems worldwide and is expected to influence cancer incidence, mortality, stage at diagnosis, and survival. This study aimed to assess COVID-19-related changes in cancer incidence observed in 2020 in the Greater Poland region.

Materials and methods

Data from the Greater Poland Cancer Registry on cancer patients diagnosed between 2010 and 2020 were analysed. To quantify the change in the number of incident cancer cases during the COVID-19 pandemic, we calculated the standardized incidence ratio (SIR) and the incidence rate difference (IRD) to assume the pandemic-attributable gap in cancer incidence.

Results

In 2020, in Greater Poland, the expected number of new cancer cases was 18 154 (9 226 among males and 8 927 among females), while the observed number was 14 770 (7 336 among males and 7 434 among females). The registered number of cancer cases decreased in 2020 by 20% (SIR 0·80, 95% CI 0·78 to 0·81) and 17% (SIR 0·83, 95% CI 0·81 to 0·85) in males and females, respectively. Among men, the most significant difference was reported for myeloma (SIR 0·59, 95% CI 0·45 to 0·77), among women for bone cancer (SIR 0·47, 95% CI 0·20 to 0·93). In females the observed incidence was higher than expected for cancer of an unspecified site (SIR 1·19, 95% CI 1·01 to 1·38). In our study, the decrease in new cancer cases was greater in males than in females.

Discussion

The observed incidence was affected in most cancer sites, with the most significant deviation from the expected number in the case of myeloma. An increase in the observed incidence was reported only in women diagnosed with cancer of an unspecified site, which might reflect shortages in access to oncological diagnostics.