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Khan MMM, Munir MM, Woldesenbet S, Endo Y, Khalil M, Tsilimigras D, Harzman A, Huang E, Kalady M, Pawlik TM. Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race/Ethnicity and Social Vulnerability. Ann Surg Oncol 2024; 31:3222-3232. [PMID: 38361094 PMCID: PMC10997707 DOI: 10.1245/s10434-024-15029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted health care delivery, including cancer screening practices. This study sought to determine the impact of the COVID-19 pandemic lockdown on colorectal cancer (CRC) screening relative to social vulnerability. METHODS Using the Medicare Standard Analytic File, individuals 65 years old or older who were eligible for guideline-concordant CRC screening between 2019 and 2021 were identified. These data were merged with the Center for Disease Control Social Vulnerability Index (SVI) dataset. Changes in county-level monthly screening volumes relative to the start of the COVID-19 pandemic (March 2020) and easing of restrictions (March 2021) were assessed relative to SVI. RESULTS Among 10,503,180 individuals continuously enrolled in Medicare with no prior diagnosis of CRC, 1,362,457 (12.97%) underwent CRC screening between 2019 and 2021. With the COVID-19 pandemic, CRC screening decreased markedly across the United States (median monthly screening: pre-pandemic [n = 76,444] vs pandemic era [n = 60,826]; median Δn = 15,618; p < 0.001). The 1-year post-pandemic overall CRC screening utilization generally rebounded to pre-COVID-19 levels (monthly median screening volumes: pandemic era [n = 60,826] vs post-pandemic [n = 74,170]; median Δn = 13,344; p < 0.001). Individuals residing in counties with the highest SVI experienced a larger decline in CRC screening odds than individuals residing in low-SVI counties (reference, low SVI: pre-pandemic high SVI [OR, 0.85] vs pandemic high SVI [OR, 0.81] vs post-pandemic high SVI [OR, 0.85]; all p < 0.001). CONCLUSIONS The COVID-19 pandemic was associated with a decrease in CRC screening volumes. Patients who resided in high social vulnerability areas experienced the greatest pandemic-related decline.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Alan Harzman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Emily Huang
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Matthew Kalady
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Hookey L, Lu T, Khan S, Reed J, Day A, Norman P. Comparison of Predictive Models for Prevention of Missed Endoscopy Appointments- failure of a Predictive Model to Outperform Overbooking Model. J Clin Gastroenterol 2024; 58:415-418. [PMID: 37436842 DOI: 10.1097/mcg.0000000000001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/17/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Patient late cancelation and nonattendance for endoscopy appointments is an ongoing problem affecting the productivity and wait times of endoscopy units. Previous research evaluated a model for predictive overbooking and had promising results. STUDY All endoscopy visits at an outpatient endoscopy unit during 4 nonconsecutive months were included in the data analysis. Patients who did not attend their appointment, or canceled with 48 hours of their appointment were considered nonattendees. Demographic, health, and prior visit behavior data was collected and the groups compared. RESULTS 1780 patients attended 2331 visits in the study period. Comparing the attendee versus non-attendees, there were significant differences in mean age, prior absenteeism, prior cancelations, and total number of hospital visits. No significant differences were seen between groups in winter versus non-winter months, the day of the week, sex distribution, type of procedure booked, or whether the referral was from specialist clinic or direct to procedure. The visit cancelation proportion (calculated excluding current visit) was substantially higher in the absentee group ( P <0.0001). A predictive model was developed and compared to current booking as well as a straight overbooking of 7%. Both overbooking models performed better than the current practice, but the predictive overbooking model did not outperform straight overbooking. CONCLUSIONS Developing an endoscopy unit specific predictive model may not be more beneficial than straight overbooking as calculated by missed appointment percentage.
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Affiliation(s)
- Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine
| | - Thomas Lu
- Gastrointestinal Diseases Research Unit, Department of Medicine
| | - Sana Khan
- Gastrointestinal Diseases Research Unit, Department of Medicine
| | - Joshua Reed
- Gastrointestinal Diseases Research Unit, Department of Medicine
| | - Andrew Day
- Clinical Research Services, Queen's University, Kingston, ON
| | - Patrick Norman
- Clinical Research Services, Queen's University, Kingston, ON
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Lofters AK, Wu F, Frymire E, Kiran T, Vahabi M, Green ME, Glazier RH. Cancer Screening Disparities Before and After the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2343796. [PMID: 37983033 PMCID: PMC10660460 DOI: 10.1001/jamanetworkopen.2023.43796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/08/2023] [Indexed: 11/21/2023] Open
Abstract
Importance Breast, cervical, and colorectal cancer-screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic. Objective To assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income. Design, Setting, and Participants This population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country's most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed. Exposures Neighborhood income quintile, immigrant status, and primary care model type. Main Outcomes and Measures For each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years. Results The overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, -9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, -3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was -1.16 (95% CI, -1.56 to -0.77); for immigrant vs nonimmigrant, the β estimate was -1.51 (95% CI, -1.84 to -1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was -1.29 (95% CI, 16 -1.53 to -1.06); for immigrant vs nonimmigrant, the β estimate was -1.41 (95% CI, -1.61 to -1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models. Conclusions and Relevance In this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.
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Affiliation(s)
- Aisha K. Lofters
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Eliot Frymire
- Health Services and Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
- ICES Queen’s, Kingston, Ontario, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Michael E. Green
- Health Services and Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
- ICES Queen’s, Kingston, Ontario, Canada
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Richard H. Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
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Shah ED, Chan WW, Jodorkovsky D, Lee Lynch K, Patel A, Patel D, Yadlapati R. Optimizing the Management Algorithm for Heartburn in General Gastroenterology: Cost-Effectiveness and Cost-Minimization Analysis. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00676-6. [PMID: 37683879 PMCID: PMC10918040 DOI: 10.1016/j.cgh.2023.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND AIMS Heartburn is the most common symptom seen in gastroenterology practice. We aimed to optimize cost-effective evaluation and management of heartburn. METHODS We developed a decision analytic model from insurer and patient perspectives comparing 4 strategies for patients failing empiric proton pump inhibitors (PPIs): (1) PPI optimization without testing, (2) endoscopy with PPI optimization for all patients, (3) endoscopy with PPI discontinuation when erosive findings are absent, and (4) endoscopy/ambulatory reflux monitoring with PPI discontinuation as appropriate for phenotypic management. Health outcomes were respectively defined on systematic reviews of clinical trials. Cost outcomes were defined on Centers for Medicare and Medicaid Services databases and commercial multipliers for direct healthcare costs, and national observational studies evaluating healthcare utilization. The time horizon was 1 year. All testing was performed off PPI. RESULTS PPI optimization without testing cost $3784/y to insurers and $3128 to patients due to lower work productivity and suboptimal symptom relief. Endoscopy with PPI optimization lowered insurer costs by $1020/y and added 11 healthy days/y by identifying erosive reflux disease. Endoscopy with PPI discontinuation added 11 additional healthy days/y by identifying patients without erosive reflux disease that did not need PPI. By optimizing phenotype-guided treatment, endoscopy/ambulatory reflux monitoring with a trial of PPI discontinuation was the most effective of all strategies (gaining 22 healthy days/y) and saved $2183 to insurers and $2396 to patients. CONCLUSIONS Among patients with heartburn, endoscopy with ambulatory reflux monitoring (off PPI) optimizes cost-effective management by matching treatment to phenotype. When erosive findings are absent, trialing PPI discontinuation is more cost-effective than optimizing PPI.
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Affiliation(s)
- Eric D Shah
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.
| | - Walter W Chan
- Division of Gastroenterology, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniela Jodorkovsky
- Division of Gastroenterology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristle Lee Lynch
- Division of Gastroenterology, Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Patel
- Division of Gastroenterology, Department of Internal Medicine, Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Dhyanesh Patel
- Division of Gastroenterology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rena Yadlapati
- Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, San Diego, California
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Sultan S. Gastrointestinal Endoscopy in Patients with Coronavirus Disease 2019: Indications, Findings, and Safety. Gastroenterol Clin North Am 2023; 52:157-172. [PMID: 36813423 PMCID: PMC9678816 DOI: 10.1016/j.gtc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed the practice of gastroenterology and how we perform endoscopy. As with any new or emerging pathogen, early in the pandemic, there was limited evidence and understanding of disease transmission, limited testing capability, and resource constraints, especially availability of personal protective equipment (PPE). As the COVID-19 pandemic progressed, enhanced protocols with particular emphasis on assessing the risk status of patients and proper use of PPE have been incorporated into routine patient care. The COVID-19 pandemic has taught us important lessons for the future of gastroenterology and endoscopy.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
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6
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van den Puttelaar R, Lansdorp-Vogelaar I, Hahn AI, Rutter CM, Levin TR, Zauber AG, Meester RGS. Impact and Recovery from COVID-19-Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis. Cancer Epidemiol Biomarkers Prev 2023; 32:22-29. [PMID: 36215205 PMCID: PMC9827109 DOI: 10.1158/1055-9965.epi-22-0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Many colorectal cancer-related procedures were suspended during the COVID-19 pandemic. In this study, we predict the impact of resulting delays in screening (colonoscopy, FIT, and sigmoidoscopy) and diagnosis on colorectal cancer-related outcomes, and compare different recovery scenarios. METHODS Using the MISCAN-Colon model, we simulated the US population and evaluated different impact and recovery scenarios. Scenarios were defined by the duration and severity of the disruption (percentage of eligible adults affected), the length of delays, and the duration of the recovery. During recovery (6, 12 or 24 months), capacity was increased to catch up missed procedures. Primary outcomes were excess colorectal cancer cases and -related deaths, and additional colonoscopies required during recovery. RESULTS With a 24-month recovery, the model predicted that the US population would develop 7,210 (0.18%) excess colorectal cancer cases during 2020-2040, and 6,950 (0.65%) excess colorectal cancer-related deaths, and require 108,500 (8.6%) additional colonoscopies per recovery month, compared with a no-disruption scenario. Shorter recovery periods of 6 and 12 months, respectively, decreased excess colorectal cancer-related deaths to 4,190 (0.39%) and 4,580 (0.43%), at the expense of 260,200-590,100 (20.7%-47.0%) additional colonoscopies per month. CONCLUSIONS The COVID-19 pandemic will likely cause more than 4,000 excess colorectal cancer-related deaths in the US, which could increase to more than 7,000 if recovery periods are longer. IMPACT Our results highlight that catching-up colorectal cancer-related services within 12 months provides a good balance between required resources and mitigation of the impact of the disruption on colorectal cancer-related deaths.
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Affiliation(s)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anne I Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Theodore R Levin
- Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reinier G S Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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7
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Le Bihan-Benjamin C, Rocchi M, Putton M, Méric JB, Bousquet PJ. Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France. JAMA Netw Open 2023; 6:e2253204. [PMID: 36701152 PMCID: PMC9880797 DOI: 10.1001/jamanetworkopen.2022.53204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
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Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Mathieu Rocchi
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Maxime Putton
- Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
- Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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8
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Gardner JG, Feld LD. The impact of COVID-19 on endoscopy and cancer screening: a focus on access and equity. Therap Adv Gastroenterol 2023; 16:17562848231173334. [PMID: 37180362 PMCID: PMC10172843 DOI: 10.1177/17562848231173334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/16/2023] [Indexed: 05/16/2023] Open
Abstract
The SARS-CoV2 pandemic has had a profound and lasting impact on healthcare delivery. Gastrointestinal endoscopy services were limited during the early phases of the pandemic, which has resulted in ongoing procedural backlog. Procedural delays have had continuing effects including delayed colorectal cancer (CRC) diagnoses and exacerbation of existing disparities in the CRC-screening and treatment pathways. In this review, we outline these effects as well as the variety of strategies that have been proposed to eliminate this backlog, including increased endoscopy hours, re-triaging of referrals, and alternative CRC-screening strategies.
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Affiliation(s)
| | - Lauren D. Feld
- Division of Gastroenterology and Hepatology, Department
of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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9
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Holland J, Cwintal M, Rigas G, Pang AJ, Vasilevsky CA, Morin N, Ghitulescu G, Faria J, Boutros M. The impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention. Surg Endosc 2022; 36:9364-9373. [PMID: 35428894 PMCID: PMC9012515 DOI: 10.1007/s00464-022-09211-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic resulted in a partial to total shutdown of endoscopy in many healthcare centers. This study aims to quantify the impact of the reduction in colonoscopies on colorectal cancer (CRC) detection and screening. METHODS After institutional ethics board approval, the endoscopy database at an academic tertiary-care center in Montreal, Canada, was searched for all colonoscopies performed from during the first wave locally (March-June 2020), and during the ramp up period where endoscopy service resumed (July to August 2020). We compared these periods to the same periods in 2019, the pre-pandemic periods. The indications, CRC and adenoma detection rates, as well as the prioritization of urgent procedures were compared. RESULTS In the first wave, only 462 colonoscopies were performed, compared to 2515 in the same period in 2019, an 82% reduction. The ramp up period saw 843 colonoscopies performed compared to 1328 in 2019, a 35% reduction. Urgent and inpatient colonoscopies numbers increased (324 (24.8%) vs. 220 (5.7%)) while surveillance and high-risk screening colonoscopies fell (376 (28.8%) vs 1869 (48.6%)). Emergency access to colonoscopy was preserved with a median time to endoscopy of < 1 day (IQR 0,1) in both pandemic periods. During the pandemic periods, there was an absolute reduction in CRC diagnosis of 28, despite the CRC detection per colonoscopy rate increasing slightly in the first wave from 1.7% (44) to 3.9% (18), and in the ramp up period from 2.5% (33) to 3.6% (31). The rate of adenoma detection per colonoscopy did not increase significantly between the pre- and pandemic periods, resulting in reduction in adenoma removal in 723 patients. DISCUSSION The restriction of access to colonoscopy resulted in a significant reduction in screening and surveillance of high-risk patients, adenomas removed, and CRCs diagnosed. Clinicians and patients will face the oncologic ramifications this the coming years.
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Affiliation(s)
- Jessica Holland
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Michelle Cwintal
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Georgia Rigas
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Allison J. Pang
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Gabriela Ghitulescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC H3T 1E2 Canada
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Dix M, Wilson CJ, Flight IH, Wassie MM, Young GP, Cock C, Cohen-Woods S, Symonds EL. Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model. Eur J Cancer Care (Engl) 2022; 31:e13713. [PMID: 36151912 DOI: 10.1111/ecc.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This is to determine whether health beliefs regarding colorectal cancer (CRC) screening could predict discomfort with a change to CRC surveillance proposing regular faecal immunochemical tests (FIT) instead of colonoscopy. METHODS Eight hundred individuals enrolled in a South Australian colonoscopy surveillance programme were invited to complete a survey on surveillance preferences. Responses were analysed using binary logistic regression predicting discomfort with a hypothetical FIT-based surveillance change. Predictor variables included constructs based on the Health Belief Model: perceived threat of CRC, perceived confidence to complete FIT and colonoscopy (self-efficacy), perceived benefits from current surveillance and perceived barriers to FIT and colonoscopy. RESULTS A total of 408 participants (51%) returned the survey (complete data n = 303; mean age 62 years, 52% male). Most participants (72%) were uncomfortable with FIT-based surveillance reducing colonoscopy frequency. This attitude was predicted by a higher perceived threat of CRC (OR = 1.03 [95% CI 1.01-1.04]), higher colonoscopy self-efficacy (OR = 1.34 [95% CI 1.13-1.59]) and lower perceived barriers to colonoscopy (OR = 0.92 [95% CI 0.86-0.99]). CONCLUSIONS Health beliefs regarding colonoscopy and perceived threat of CRC may be important to consider when changing CRC surveillance protocols. If guideline changes were introduced, these factors should be addressed to provide patients reassurance concerning the efficacy of the alternative protocol.
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Affiliation(s)
- Maddison Dix
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Austin Health, Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid H Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Molla M Wassie
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Charles Cock
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sarah Cohen-Woods
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,College of Education, Psychology, and Social Work, Flinders University, Bedford Park, South Australia, Australia.,Orama Institute for Mental Health and Well-Being, Flinders University, Bedford Park, South Australia, Australia
| | - Erin L Symonds
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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11
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Gawron AJ, Sultan S, Glorioso TJ, Califano S, Kralovic SM, Jones M, Kirsh S, Dominitz JA. Pre-endoscopy coronavirus disease 2019 screening and severe acute respiratory syndrome coronavirus-2 nucleic acid amplification testing in the Veterans Affairs healthcare system: clinical practice patterns, outcomes, and relationship to procedure volume. Gastrointest Endosc 2022; 96:423-432.e7. [PMID: 35461889 PMCID: PMC9023088 DOI: 10.1016/j.gie.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/12/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts worldwide, including on the performance of GI endoscopy. We aimed to describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs healthcare system and describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services. METHODS COVID-19 screening and NAAT results from March 2020 to April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends. RESULTS Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented preprocedure COVID-19 symptom and exposure screenings and 154,127 (69.8%) had preprocedure NAAT results within 7 days before scheduled endoscopy. Of 131,894 total canceled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and canceled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% confidence interval [CI], 32.4%-36.8%) and 96.4% specificity (95% CI, 96.2%-96.5%) when compared with NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI, 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI, 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = .09). CONCLUSIONS These findings have important implications for decisions about preprocedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.
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Affiliation(s)
- Andrew J. Gawron
- National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VAHCS, Minneapolis, Minnesota, USA
| | - Thomas J. Glorioso
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | - Sophia Califano
- Preventive Medicine, National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Washington, DC, USA,General Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Stephen M. Kralovic
- National Infectious Diseases Service, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,Medical Service, Cincinnati VA Medical Center, Cincinnati, Ohio, USA,Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Makoto Jones
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan Kirsh
- Office of Veterans Access to Care, Veterans Health Administration, Washington, DC, USA
| | - Jason A. Dominitz
- National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA,VA Puget Sound Health Care System, Seattle, Washington, USA,Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA,Reprint requests: Jason A. Dominitz, MD, MHS, VA Puget Sound Health Care System, Seattle Division (111-S-Gastro), 1660 S Columbian Way, Seattle, WA 98108
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12
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Bian DJH, Sabri S, Abdulkarim BS. Interactions between COVID-19 and Lung Cancer: Lessons Learned during the Pandemic. Cancers (Basel) 2022; 14:cancers14153598. [PMID: 35892857 PMCID: PMC9367272 DOI: 10.3390/cancers14153598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary COVID-19 is a respiratory infectious disease caused by the coronavirus SARS-CoV-2. Lung cancer is the leading cause of all cancer-related deaths worldwide. As both SARS-CoV-2 and lung cancer affect the lungs, the aim of this narrative review is to provide a consolidation of lessons learned throughout the pandemic regarding lung cancer and COVID-19. Risk factors found in lung cancer patients, such as advanced cancers, smoking, male, etc., have been associated with severe COVID-19. The cancer treatments hormonal therapy, immunotherapy, and targeted therapy have shown no association with severe COVID-19 disease, but chemotherapy and radiation therapy have shown conflicting results. Logistical changes and modifications in treatment plans were instituted during the pandemic to minimize SARS-CoV-2 exposure while maintaining life-saving cancer care. Finally, medications have been developed to treat early COVID-19, which can be highly beneficial in vulnerable cancer patients, with paxlovid being the most efficacious drug currently available. Abstract Cancer patients, specifically lung cancer patients, show heightened vulnerability to severe COVID-19 outcomes. The immunological and inflammatory pathophysiological similarities between lung cancer and COVID-19-related ARDS might explain the predisposition of cancer patients to severe COVID-19, while multiple risk factors in lung cancer patients have been associated with worse COVID-19 outcomes, including smoking status, older age, etc. Recent cancer treatments have also been urgently evaluated during the pandemic as potential risk factors for severe COVID-19, with conflicting findings regarding systemic chemotherapy and radiation therapy, while other therapies were not associated with altered outcomes. Given this vulnerability of lung cancer patients for severe COVID-19, the delivery of cancer care was significantly modified during the pandemic to both proceed with cancer care and minimize SARS-CoV-2 infection risk. However, COVID-19-related delays and patients’ aversion to clinical settings have led to increased diagnosis of more advanced tumors, with an expected increase in cancer mortality. Waning immunity and vaccine breakthroughs related to novel variants of concern threaten to further impede the delivery of cancer services. Cancer patients have a high risk of severe COVID-19, despite being fully vaccinated. Numerous treatments for early COVID-19 have been developed to prevent disease progression and are crucial for infected cancer patients to minimize severe COVID-19 outcomes and resume cancer care. In this literature review, we will explore the lessons learned during the COVID-19 pandemic to specifically mitigate COVID-19 treatment decisions and the clinical management of lung cancer patients.
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Affiliation(s)
- David J. H. Bian
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada;
| | - Siham Sabri
- Cancer Research Program, Research Institute, McGill University Health Center Glen Site, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Bassam S. Abdulkarim
- Cancer Research Program, Research Institute, and Department of Oncology, Cedars Cancer Center, McGill University Health Center Glen Site, McGill University, Montreal, QC H4A 3J1, Canada
- Correspondence:
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13
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Forse CL, Petkiewicz S, Teo I, Purgina B, Klaric KA, Ramsay T, Wasserman JK. Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada. J Can Assoc Gastroenterol 2022; 5:137-142. [PMID: 35664369 PMCID: PMC8754725 DOI: 10.1093/jcag/gwab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background In March 2020, a directive to halt all elective and non-urgent procedures was issued in Ontario, Canada because of COVID-19. The directive caused a temporary slowdown of screening programs including surveillance colonoscopies for colorectal cancer (CRC). Our goal was to determine if there was a difference in patient and tumour characteristics between CRC patients treated surgically prior to the COVID-19 directive compared to CRC patients treated after the slowdown. Methods CRC resections collected within the Champlain catchment area of eastern Ontario in the 6 months prior to COVID-19 (August 1, 2019-January 31, 2020) were compared to CRC resections collected in the 6 months post-COVID-19 slowdown (August 1, 2020-January 31, 2021). Clinical (e.g., gender, patient age, tumour site, and clinical presentation) and pathological (tumour size, tumour stage, nodal stage, and lymphovascular invasion) features were evaluated using chi-square tests, T-tests, and Mann-Whitney tests where appropriate. Results Three hundred and thirty-eight CRC specimens were identified (173 pre-COVID-19, 165 post-COVID-19 slowdown). CRC patients treated surgically post-COVID-19 slowdown had larger tumours (44 mm vs. 35 mm; P = 0.0048) and were more likely to have presented emergently (24% vs. 10%; P < 0.001). Although there was a trend towards higher tumour stage, nodal stage, and clinical stage, these differences did not reach statistical significance. Other demographic and pathologic variables including patient gender, age, and tumour site were similar between the two cohorts. Interpretation The COVID-19 slowdown resulted in a shift in the severity of disease experienced by CRC patients in Ontario. Pandemic planning in the future should consider the long-term consequences to cancer diagnosis and management.
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Affiliation(s)
- Catherine L Forse
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stephanie Petkiewicz
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Iris Teo
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kristina-Ana Klaric
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jason K Wasserman
- Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Laboratory Association, and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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14
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Walker MJ, Wang J, Mazuryk J, Skinner SM, Meggetto O, Ashu E, Habbous S, Nazeri Rad N, Espino-Hernández G, Wood R, Chaudhry M, Vahid S, Gao J, Gallo-Hershberg D, Gutierrez E, Zanchetta C, Langer D, Zwicker V, Rey M, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Singh S, Warde P, Forbes L, Dobranowski J, Irish J, Rabeneck L. Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e228855. [PMID: 35467731 PMCID: PMC9039771 DOI: 10.1001/jamanetworkopen.2022.8855] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has impacted cancer systems worldwide. Quantifying the changes is critical to informing the delivery of care while the pandemic continues, as well as for system recovery and future pandemic planning. OBJECTIVE To quantify change in the delivery of cancer services across the continuum of care during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study assessed cancer screening, imaging, diagnostic, treatment, and psychosocial oncological care services delivered in pediatric and adult populations in Ontario, Canada (population 14.7 million), from April 1, 2019, to March 1, 2021. Data were analyzed from May 1 to July 31, 2021. EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Cancer service volumes from the first year of the COVID-19 pandemic, defined as April 1, 2020, to March 31, 2021, were compared with volumes during a prepandemic period of April 1, 2019, to March 31, 2020. RESULTS During the first year of the pandemic, there were a total of 4 476 693 cancer care services, compared with 5 644 105 services in the year prior, a difference of 20.7% fewer services of cancer care, representing a potential backlog of 1 167 412 cancer services. While there were less pronounced changes in systemic treatments, emergency and urgent imaging examinations (eg, 1.9% more parenteral systemic treatments) and surgical procedures (eg, 65% more urgent surgical procedures), major reductions were observed for most services beginning in March 2020. Compared with the year prior, during the first pandemic year, cancer screenings were reduced by 42.4% (-1 016 181 screening tests), cancer treatment surgical procedures by 14.1% (-8020 procedures), and radiation treatment visits by 21.0% (-141 629 visits). Biopsies to confirm cancer decreased by up to 41.2% and surgical cancer resections by up to 27.8% during the first pandemic wave. New consultation volumes also decreased, such as for systemic treatment (-8.2%) and radiation treatment (-9.3%). The use of virtual cancer care increased for systemic treatment and radiation treatment and psychosocial oncological care visits, increasing from 0% to 20% of total new or follow-up visits prior to the pandemic up to 78% of total visits in the first pandemic year. CONCLUSIONS AND RELEVANCE In this population-based cohort study in Ontario, Canada, large reductions in cancer service volumes were observed. While most services recovered to prepandemic levels at the end of the first pandemic year, a substantial care deficit likely accrued. The anticipated downstream morbidity and mortality associated with this deficit underscore the urgent need to address the backlog and recover cancer care and warrant further study.
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Affiliation(s)
- Meghan J. Walker
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | | | - Eta Ashu
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | | | | | - Ryan Wood
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | - Saba Vahid
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Julia Gao
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | | | | | | | - Michelle Rey
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Martin C. Tammemägi
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Health Sciences, Brock University, St Catharines, Canada
| | - Jill Tinmouth
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rachel Kupets
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Anna M. Chiarelli
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simron Singh
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, , Canada
| | - Padraig Warde
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Leta Forbes
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Canada
| | - Julian Dobranowski
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Radiology, McMaster University, Hamilton, Canada
- Niagara Health, St Catharines, Ontario, Canada
| | - Jonathan Irish
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Linda Rabeneck
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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15
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Colorectal Surgery in the COVID-19 Era: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14051229. [PMID: 35267537 PMCID: PMC8909364 DOI: 10.3390/cancers14051229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: To determine the impact of the COVID-19 pandemic in the management of colorectal cancer patients requiring surgery and to examine whether the restructuring of healthcare systems led to cancer stage upshifting or adverse treatment outcomes; (2) Methods: A systematic literature search of the MedLine, Scopus, Web of Science, and CNKI databases was performed (PROSPERO ID: CRD42021288432). Data were summarized as odds ratios (OR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs); (3) Results: Ten studies were examined, including 26,808 patients. The number of patients presenting with metastases during the pandemic was significantly increased (OR 1.65, 95% CI 1.02−2.67, p = 0.04), with no differences regarding the extent of the primary tumor (T) and nodal (N) status. Patients were more likely to have undergone neoadjuvant therapy (OR 1.22, 95% CI 1.09−1.37, p < 0.001), while emergency presentations (OR 1.74, 95% CI 1.07−2.84, p = 0.03) and palliative surgeries (OR 1.95, 95% CI 1.13−3.36, p = 0.02) were more frequent during the pandemic. There was no significant difference recorded in terms of postoperative morbidity; (4) Conclusions: Patients during the pandemic were more likely to undergo palliative interventions or receive neoadjuvant treatment.
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16
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Tan CM, Bernstein M, Raboud J, Mannino B, Tinmouth J. OUP accepted manuscript. J Can Assoc Gastroenterol 2022; 5:e57-e64. [PMID: 35919763 PMCID: PMC9340627 DOI: 10.1093/jcag/gwac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Endoscopy units are being challenged to provide timely and quality care, despite limited resources and an ever-growing patient population. Decreasing procedure time is unlikely to create sufficient time savings and may compromise quality. Non-procedural factors, such as room turnover, are important contributors to efficiency and represent an ideal target for quality improvement efforts. Aims The objective of this quality improvement study was to identify practices that will improve endoscopy unit efficiency at our centre. The specific aims were to (a) understand practices at local hospitals that contribute to room turnover efficiency and (b) examine the magnitude and sources of variation in room turnover efficiency across endoscopists and nurses at our centre. Methods Interviews were conducted with team leads at five local hospitals. Routinely collected data from our centre were analyzed to understand the magnitude and variation in efficiency by provider and reasons for delays. Non-procedure time defined as ‘patient 1 scope out’ to ‘patient 2 scope in’ was our primary measure of efficiency. Results Over the 12-month period, 750 outpatient procedures met inclusion criteria. Median non-procedure time was 19 min (interquartile range: 16–22 min). The variation attributable to endoscopists was 14.7% compared to 80.4% for unmeasured factors. Conclusions The variation that remains unexplained by our model suggests that unmeasured factors play a substantial role in endoscopy unit efficiency and that our current endoscopy records are not capturing important contributors to efficiency. The next phase will involve focus groups and direct observation with the goal of identifying these unmeasured factors.
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Affiliation(s)
- Carolyn Michelle Tan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Bernstein
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Janet Raboud
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Benedetta Mannino
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Correspondence: Jill Tinmouth, MD, PhD, Sunnybrook Health Sciences Centre, HG40 - 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5, e-mail:
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17
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Purich K, Zhou Y, Dodd S, Yuan Y, White J. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer? An observational study. Int J Colorectal Dis 2022; 37:573-582. [PMID: 34786597 PMCID: PMC8594862 DOI: 10.1007/s00384-021-04063-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Rectal bleeding is a common symptom of colorectal cancer. In this paper, we describe and evaluate the operation of a central access and triage system for patients with rectal bleeding, which uses a "high-risk"/ "low-risk" designation based on the referring doctor's subjective designation and a 10-item symptom checklist. METHODS A total of 1846 patients, referred between February 1, 2016, and December 31, 2018, were included. Exclusion criteria were the following: incorrect patient identification number, duplicate records, and pre-diagnosed gastrointestinal cancer. Data was obtained by chart review. Sensitivity, specificity, and positive and negative predictive values were calculated for each item on the symptom checklist. RESULTS Eight hundred seventy-nine (48%) patients received endoscopy, and 37 (2%) were found to have cancer. Five hundred eighty-two (32%) patients were deemed high-risk. Twenty-nine (78%) of the patients with cancer were in the high-risk group. Patients in the high-risk group had a higher incidence of cancer (5.0% vs 0.6%, p < 0.001) and shorter waits to endoscopy (201 vs 292 days). Patients designated as high-risk by the referring physician had a relative risk of 22.3 compared to those designated as low-risk. Patients deemed high-risk by the symptom checklist had a relative risk of 3.5 compared to low-risk patients. CONCLUSION Our system stratified 29/37 (78%) of the patients found to have cancer as high-risk. A total of 8/37 (22%) patients with cancer were deemed low-risk. Our research has identified two variables (weight loss and anemia) which have been added to our referral symptom checklist. This study helped us identify areas for refinement of our triage system. These findings are of interest to physicians who treat colorectal cancer.
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Affiliation(s)
- Kieran Purich
- Department of Surgery, University of Alberta Faculty of Medicine and Dentistry, c/o Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB Canada ,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada
| | - Yiling Zhou
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Shawn Dodd
- Department of Surgery, University of Alberta Faculty of Medicine and Dentistry, c/o Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB Canada ,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Jonathan White
- Department of Surgery, University of Alberta Faculty of Medicine and Dentistry, c/o Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB Canada ,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada
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18
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Sultan S, Siddique SM, Singh S, Altayar O, Caliendo AM, Davitkov P, Feuerstein JD, Kaul V, Lim JK, Mustafa RA, Falck-Ytter Y, Inadomi JM. AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update. Gastroenterology 2021; 161:1011-1029.e11. [PMID: 34029569 PMCID: PMC8139430 DOI: 10.1053/j.gastro.2021.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology at the University of Rochester Medical Center, Rochester, New York
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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19
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Walker E, Fu Y, Sadowski DC, Stewart D, Tang P, Kaposhi B, Chappell H, Robson P, Veldhuyzen van Zanten S. Delayed Colorectal Cancer Diagnosis during the COVID-19 Pandemic in Alberta: A Framework for Analyzing Barriers to Diagnosis and Generating Evidence to Support Health System Changes Aimed at Reducing Time to Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179098. [PMID: 34501687 PMCID: PMC8430515 DOI: 10.3390/ijerph18179098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016–4 March 2020) and intra-pandemic (5 March 2020–1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.
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Affiliation(s)
- Emily Walker
- Surveillance and Reporting, Advanced Analytics, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada; (Y.F.); (B.K.)
- Correspondence:
| | - Yunting Fu
- Surveillance and Reporting, Advanced Analytics, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada; (Y.F.); (B.K.)
| | - Daniel C. Sadowski
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2X8, Canada; (D.C.S.); (S.V.v.Z.)
| | - Douglas Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3H1, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada;
| | - Patricia Tang
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada;
| | - Bethany Kaposhi
- Surveillance and Reporting, Advanced Analytics, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada; (Y.F.); (B.K.)
| | - Heather Chappell
- Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3C6, Canada; (H.C.); (P.R.)
| | - Paula Robson
- Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3C6, Canada; (H.C.); (P.R.)
| | - Sander Veldhuyzen van Zanten
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2X8, Canada; (D.C.S.); (S.V.v.Z.)
- Digestive Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
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20
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Mazidimoradi A, Tiznobaik A, Salehiniya H. Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: a Systematic Review. J Gastrointest Cancer 2021; 53:730-744. [PMID: 34406626 PMCID: PMC8371036 DOI: 10.1007/s12029-021-00679-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 12/13/2022]
Abstract
Background After the World Health Organization (WHO) announcing about global pandemic of COVID-19 in March 2020 and relocation of health care resources for controlling this infection, cancer screening programs especially colorectal cancer (CRC) have been suspended in many countries. According to GLOBOCAN 2020 data, CRC is the third prevalent and second deadliest cancer in the world. So, early detection through screening is essential to reduce the mortality associated with this cancer. The present study was designed to investigate the impact of COVID-19 pandemic on colorectal cancer screening. Methods and Materials A comprehensive search performed on June 2021 in various databases, including Medline, Web of Science, and Scopus. Keywords such as “Early Detection,” “Cancer,” “Cancer Screening,” “Cancer Screening Tests,” “Coronavirus Disease-19,” “COVID 19,” “Coronavirus Disease,” “SARS-CoV-2 Infection,” “SARS-CoV-2,” “2019-nCoV,” “coronavirus, 2019 Novel,” “SARS COV 2 Virus,” “Severe Acute Respiratory Syndrome Coronavirus 2,” “COVID-19,” “COVID-19, Coronavirus Disease 19,” “SARS Coronavirus 2”,“Colorectal neoplasm” and “Colorectal Cancer“ were used individually or in combination to search. All articles were entered into Endnote X7 software that remove duplicates. Then, studies were first selected by title and then by abstract and at the end full texts were investigated. Results Of the 850 identified studies, 25 were identified as eligible. The results of studies show that in general, colorectal cancer screening has decreased from 28 to 100% in different countries and at different times after the onset of the COVID-19 pandemic. During this period, only 2 to 2.5% of hospitals and screening centers with 100% capacity continued to operate, and more than 77% of them limited their activities to less than 10% of their normal capacity. Also, completion of colonoscopies requiring examination showed a decrease of 65.7%, surveillance colonoscopy showed a decrease of 44.6 to 79%, prescription colonoscopy decreased 60 to 81%, and referrals to colonoscopy showed a 43% decline. However, emergency colonoscopy shows a 2 to 9% increase. The use of the Fecal immunochemical test (FIT) test is also generally declining but is increasing in areas used as a colonoscopy alternative. Conclusions Considering that the reduction in colorectal cancer screening following COVID-19 pandemic is due to the restrictions imposed for the high prevalence of COVID-19 disease and the lack of referrals due to the fear of developing COVID-19 infection; compensating for the decline and preventing the continuation of this decreasing trend requires serious and effective interventions to maintain the capacity of screening services during the COVID-19 crisis, increase the capacity of screening centers during the lifting of restrictions and reduce fear in the public.
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Affiliation(s)
| | - Azita Tiznobaik
- Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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21
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Dubé C. Re-FIT-ting Colorectal Cancer Screening During and Beyond COVID. Gastroenterology 2021; 161:418-420. [PMID: 33974936 PMCID: PMC8188308 DOI: 10.1053/j.gastro.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Catherine Dubé
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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22
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Wassie MM, Agaciak M, Cock C, Bampton P, Young GP, Symonds EL. The impact of coronavirus disease 2019 on surveillance colonoscopies in South Australia. JGH Open 2021; 5:486-492. [PMID: 33869788 PMCID: PMC8035475 DOI: 10.1002/jgh3.12525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM The coronavirus disease 2019 (COVID-19) global pandemic has affected elective procedures, including colonoscopy, worldwide. Delayed colorectal cancer surveillance may increase cancer risk. This study aimed to determine the impact of COVID-19 on the proportion of surveillance colonoscopies booked and completed and the extent to which that surveillance was delayed. METHODS This was a retrospective analysis of colonoscopy data during the 3 months (April-June 2020) when clinical services were most affected by COVID-19 in South Australia compared to the same period in 2019. Data on colonoscopies and responses to surveillance recall letters were reviewed to determine the numbers and proportions of colonoscopies that were delayed. RESULTS During 2020, the total number of colonoscopies decreased by 51.1% (n = 569) compared to 2019 (n = 1164). In 2019, 45.5% (n = 530) of colonoscopies were completed for surveillance, but this proportion decreased to 32.0% (n = 182) during 2020, an overall decrease in the number of surveillance colonoscopies of 65.6%. Of surveillance colonoscopies that were due in 2020, 46.1% (134/291) were delayed >6 months, a significant increase compared to 2019 (19.3%; 59/306, P < 0.001). A decrease in response to surveillance recall letters was only observed in patients ≥75 years, with more nonresponders (51.6%) in 2020 compared to that observed in 2019 (25.6%, P = 0.03). CONCLUSIONS Significant delays in surveillance colonoscopies occurred during the COVID-19 pandemic in South Australia. These effects are likely to be in areas more severely affected by the pandemic. Planning for post-COVID-19 colonoscopy capacity is required to avoid cancer progression due to delays in surveillance colonoscopies.
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Affiliation(s)
- Molla M Wassie
- Cancer Research, Flinders Health and Medical Research, Flinders UniversityBedford ParkSouth AustraliaAustralia
- Department of Human NutritionInstitute of Public Health, College of Medicine and Public Health, Gondar UniversityGondarEthiopia
| | - Madelyn Agaciak
- Department of MedicineCollege of Medicine and Public Health, Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Charles Cock
- Cancer Research, Flinders Health and Medical Research, Flinders UniversityBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and Hepatology, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Peter Bampton
- Cancer Research, Flinders Health and Medical Research, Flinders UniversityBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and Hepatology, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Graeme P Young
- Cancer Research, Flinders Health and Medical Research, Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Erin L Symonds
- Cancer Research, Flinders Health and Medical Research, Flinders UniversityBedford ParkSouth AustraliaAustralia
- Bowel Health Service, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
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