ABSTRACT
Purpose/Background: With enhanced strain on healthcare systems and avoidance of routine surgery and systemic therapy during the COVID-19 period due to increased morbidity and mortality alternative oncological approaches have been employed. We aimed to determine the variation in strategies adopted nationally across the United Kingdom (UK) and long-term associated outcomes. Methods/Interventions: A UK multi-centre prospective observational study was performed from the date of National Governmental lockdown (23/3/20) until the lifting of restrictions (17/5/21). Patients with a new diagnosis of rectal cancer or those rediscussed at MDT on an existing treatment pathway were eligible for inclusion. Results/Outcomes: The first 900 patients were reported from 70 registered sites;65.4% male, 73.6% >60 years old. 62.4% of patients were diagnosed following lockdown. 65.8% of MDTs had a partial or entirely virtual format. 22.8% of tumours were T4, with 4.3% local recurrence. Following lockdown there was a significant increase in the use of SCRT + delay from 10.0% to 18.7% (p < 0.0005), with a rate of 26.7% during the first wave. Comparably the rate of LCRT fell 53.3% to 18.0% (p < 0.0001). 86.2% of those undergoing surgery during the first wave had stoma formation, 26.0% of which due to COVID-19 concerns alone. 18.6% of patients were deemed to have received different management plans due to COVID-19. Conclusion/Discussion: The COVID-19 pandemic has led to variation in oncological treatment strategies for rectal cancer, most notably an increase in the use of SCRT radiotherapy, deferral of surgery and stoma formation. Whilst short-term data appears to suggest equivalence in outcomes compared to LCRT, caution needs to be shown whilst awaiting longer-term outcomes and ensuring robust follow up and safety netting to avoid long term harm.