Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic
Author(s)
Type
Journal Article
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.
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.
Date Issued
2020-10-08
Date Acceptance
2020-09-26
Citation
PLoS One, 2020, 15 (10), pp.1-13
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Start Page
1
End Page
13
Journal / Book Title
PLoS One
Volume
15
Issue
10
Copyright Statement
© 2020 Mason et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000581809800004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
RDB04 79560
RD207
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
CANCER
DELAY
RISK
Publication Status
Published
Article Number
ARTN e0240397
Date Publish Online
2020-10-08