Impact of two waves of Sars-Cov2 outbreak on the number, clinical presentation, care trajectories and survival of patients newly referred for a colorectal cancer: A French multicentric cohort study from a large group of university hospitals

Abstract

The SARS-Cov2 may have impaired care trajectories, patient overall survival (OS), tumor stage at initial presentation for new colorectal cancer (CRC) cases. This study aimed at assessing those indicators before and after the beginning of the pandemic in France. In this retrospective cohort study, we collected prospectively the clinical data of the 11.4 million of patients referred to the Greater Paris University Hospitals (AP-HP). We identified new CRC cases between 1 January 2018 and 31 December 2020, and compared indicators for 2018-2019 to 2020. pTNM tumor stage was extracted from postoperative pathology reports for localized colon cancer, and metastatic status was extracted from CT-scan baseline text reports. Between 2018 and 2020, 3602 and 1083 new colon and rectal cancers were referred to the AP-HP, respectively. The 1-year OS rates reached 94%, 93% and 76% for new CRC patients undergoing a resection of the primary tumor, in 2018-2019, in 2020 without any Sars-Cov2 infection and in 2020 with a Sars-Cov2 infection, respectively (HR 3.78, 95% CI 2.1-7.1). For patients undergoing other kind of anticancer treatment, the percentages are 64%, 66% and 27% (HR 2.1, 95% CI 1.4-3.3). Tumor stage at initial presentation, emergency level of primary tumor resection, delays between the first multidisciplinary meeting and the first anticancer treatment did not differ over time. The SARS-Cov2 pandemic has been associated with less newly diagnosed CRC patients and worse 1-year OS rates attributable to the infection itself rather than to its impact on hospital care delivery or tumor stage at initial presentation.

Keywords: COVID-19; colorectal neoplasms; delivery of health care; health services research; quality of health care.

FIGURE 1

Evolution of the cumulative monthly number of new cancer cases of colon (A) and rectum (B), primary tumor resections for colon (C) and rectum (D) over time referred to Greater Paris University Hospitals teaching hospital, in 2018‐2019 and 2020, respectively [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

One‐year overall survival rates of patients undergoing an anticancer treatment at the AP‐HP hospital for a CRC between 2018 and 2019 (blue), and in 2020 (orange) with a resection of the primary tumor (A) and without any tumor resection (B), according to the occurrence of a Sars Cov2 infection [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Flowchart of care trajectories for patients with a surgical resection of their colorectal primary tumor, according to the level of surgery emergency between 2018 and 2020 at the Greater Paris University Hospitals teaching hospital [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

The rate of patients operated from their colorectal primary tumor, according to the level of surgery emergency between 2018 and 2020 at the Greater Paris University Hospitals (gray zones refer to the French lockdowns time periods) [Color figure can be viewed at wileyonlinelibrary.com]