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Multicenter Study
. 2022 Sep 2;27(9):e723-e730.
doi: 10.1093/oncolo/oyac129.

Alarming Drop in Early Stage Colorectal Cancer Diagnoses After COVID-19 Outbreak: A Real-World Analysis from the Italian COVID-DELAY Study

Giulia Mentrasti  1 , Luca Cantini  1 , Clizia Zichi  2 , Nicola D'Ostilio  3 , Fabio Gelsomino  4 , Erika Martinelli  5 , Rita Chiari  6 , Nicla La Verde  7 , Renato Bisonni  8 , Valeria Cognigni  1 , Giada Pinterpe  1 , Federica Pecci  1 , Antonella Migliore  1 , Giacomo Aimar  2 , Francesca De Vita  2 , Donatella Traisci  9 , Andrea Spallanzani  4 , Giulia Martini  5 , Linda Nicolardi  6 , Maria Silvia Cona  7 , Maria Giuditta Baleani  8 , Marco Luigi Bruno Rocchi  10 , Rossana Berardi  1
Affiliations
Multicenter Study

Alarming Drop in Early Stage Colorectal Cancer Diagnoses After COVID-19 Outbreak: A Real-World Analysis from the Italian COVID-DELAY Study

Giulia Mentrasti et al. Oncologist. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) has triggered the disruption of health care on a global scale. With Italy tangled up in the pandemic response, oncology care has been largely diverted and cancer screenings suspended. Our multicenter Italian study aimed to evaluate whether COVID-19 has impacted access to diagnosis, staging, and treatment for patients newly diagnosed with colorectal cancer (CRC), compared with pre-pandemic time.

Methods: All consecutive new CRC patients referred to 8 Italian oncology institutions between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019.

Results: A reduction (29%) in newly diagnosed CRC cases was seen when compared with 2019 (360 vs 506). New CRC patients in 2020 were less likely to be diagnosed with early stage (stages I-II-III) CRC (63% vs 78%, P < .01). Gender and sidedness were similar regardless of the year. The percentage of tumors with any mutation among BRAF, NRAS, and KRAS genes were significantly different between the 2 years (61% in 2020 vs 50% in 2019, P = .04). Timing of access to cancer diagnosis, staging, and treatment for patients with CRC has not been negatively affected by the pandemic. Significantly shorter temporal intervals were observed between symptom onset and first oncological appointment (69 vs 79 days, P = .01) and between histological diagnosis and first oncological appointment (34 vs 42 days, P < .01) during 2020 compared with 2019. Fewer CRC cases were discussed in multidisciplinary meetings during 2020 (38% vs 50%, P = .01).

Conclusions: Our data highlight a significant drop in CRC diagnosis after COVID-19, especially for early stage disease. The study also reveals a remarkable setback in the multidisciplinary management of patients with CRC. Despite this, Italian oncologists were able to ensure diagnostic-therapeutic pathways proper operation after March 2020.

Keywords: COVID-19; colorectal cancer; diagnostic delay; multidisciplinary discussions; therapeutic delay.

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Figures

Figure 1.
Figure 1.
Flow diagram of COVID-DELAY study population.
Figure 2.
Figure 2.
Monthly differences of new colorectal cancer diagnoses between 2019 and 2020. April, May, and June 2020 (in bold type) were considered as the lockdown timeframe.
Figure 3.
Figure 3.
(a) Difference of colorectal cancer stages at diagnosis between 2019 and 2020 (percentages were calculated on the total number of new diagnoses each year taking into account also the number of unknown stages at diagnosis). (b) Difference of colorectal cancer cases discussed during multidisciplinary team meetings between 2019 and 2020.
See this image and copyright information in PMC

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