ABSTRACT
Aim: To evaluate the impact of telemedicine on the diagnosis of colorectal cancer during and after the COVID 19 pandemic. Method(s): 120 -200 patients/year are diagnosed with colorectal cancer at Darent Valley Hospital. Our database of colorectal cancer patients from 2018 to 2022 was reviewed and patients stratified according to staging and diagnostic pathway (e.g. screening, rapid access referral or emergency admission). These data were compared pre-, during and post-Covid 19 pandemic. Where possible, local data were compared with available national statistics. Result(s): Our analysis suggests that there has been an increase in patients presenting with advanced (T3/T4) colorectal cancer during and after the pandemic. Several had experienced telemedicine consultations and triage both in primary and secondary care and had never been physically examined by a healthcare professional. A comprehensive analysis of these cases will be presented. Conclusion(s): Data from the UK suggests that the Covid-19 pandemic led to a significant reduction in the diagnosis and treatment of colorectal cancer. This implies that there are a large number of people in the community with undiagnosed colorectal cancer, who may subsequently present with advanced disease. As the early detection of cancer improves outcomes, delays to diagnosis could negatively impact survival from colorectal cancer. The COVID-19 pandemic has led to a rise in tele-medicine and the NHS has recommended that >25% of outpatient appointments should take place remotely. However, the suitability of this mode of communication in surgery has been questioned, especially in the assessment of new patients. It is our concern that an over-reliance on telemedicine is causing delays in the physical examination of patients and may be associated with the apparent increase in patients presenting with advanced colorectal cancer. New pathways should be developed for a post-pandemic NHS to ensure that potential cancer patients are physically seen in a timely manner.
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.