Impact and Recovery from COVID-19-Related Disruptions in Colorectal Cancer Screening and Care in the US: A Scenario Analysis

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.

Figure 1.

Published estimates of the decrease in colorectal cancer screening (A) and diagnosis (B) as a result of the COVID-19 pandemic identified by our literature search (2, 4, 26–36). The modeled severity of disruption was determined by taking the average across all studies (solid line). From September 2020, the average decrease of the last three months with available data was used as severity of disruption for preventive services. The average ratio between preventive and diagnostic procedures from March 2020 to September 2020 was used to set the severity of disruption for diagnostic procedures for the remaining months of the disruption period. EHRN, Epic Health Research Network.

Figure 2.

Cumulative excess colorectal cancer cases (A) and deaths (B) compared with a scenario without pandemic-induced delays over time for different recovery scenarios.

Figure 3.

Average change in preventive (A) and diagnostic (B) procedures by month during the disruption and recovery period compared with the scenario without pandemic-induced delays. Preventive procedures include primary colonoscopy, sigmoidoscopy, and surveillance colonoscopy.