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Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic.

ABSTRACT: BACKGROUND:There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation. OBJECTIVE:To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change. DESIGN:An online survey of colorectal cancer service change globally in May and June 2020. PARTICIPANTS:Attending or consultant surgeons involved in the care of patients with colorectal cancer. MAIN OUTCOME MEASURES:Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region. RESULTS:191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need. CONCLUSIONS:The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.

SUBMITTER: Mason SE

PROVIDER: S-EPMC7544024 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic.

Mason Sam E SE Scott Alasdair J AJ Markar Sheraz R SR Clarke Jonathan M JM Martin Guy G Winter Beatty Jasmine J Sounderajah Viknesh V Yalamanchili Seema S Denning Max M Arulampalam Thanjakumar T Kinross James M JM

PloS one 20201008 10

<h4>Background</h4>There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation.<h4>Objective</h4>To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change.<h4>Design</h4>An online survey of colorectal cancer service change globally in May and June 2020.<h4>Participants</h4>Attending or consultant surgeons involved in the care of patients with colorectal cancer.<h4>Main outcome mea ...[more]

PMID: 33031464

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Project description:Globally, 28.4 million non-emergent ('elective') surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019-24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%-73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%-16.5%. For CRC, this ranged from 0%-70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.

Dataset Information

Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic.

Publications

Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic.

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