Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Mahmoud Alrahawy; Charles Johnson; Medhet Aker; Hazim A Eltyeb; Susan Green

doi:10.7759/cureus.32037

Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer

Cureus. 2022 Nov 30;14(11):e32037. doi: 10.7759/cureus.32037. eCollection 2022 Nov.

Authors

Mahmoud Alrahawy^{1

2}, Charles Johnson², Medhet Aker³, Hazim A Eltyeb⁴, Susan Green²

Affiliations

¹ Department of General Surgery, Menoufia University, Menoufia, EGY.
² General and Colorectal Surgery, Durham University Hospital, Durham, GBR.
³ General and Colorectal Surgery, Colchester Hospital University, Colchester, GBR.
⁴ General Surgery, Health Education North East, Newcastle, GBR.

Abstract

Aim: This study compares the stage at the presentation of patients with colorectal cancer (CRC) before and after introducing COVID-19 restrictions and the mode of presentation.

Methods: This is a retrospective cohort study comparing the incidence of CRC, TNM stage and mode of presentation in the pre-COVID and COVID cohorts at a single UK Trust. All patients discussed at the CRC multidisciplinary team (MDT) from March 2017 to March 2021 were included and split into two cohorts; the pre-COVID group from 01/03/2017 to 29/02/2020 and the COVID group from 01/03/2020 to 28/02/2021. Percentages were used for descriptive statistics. Student's t-test was used for the comparison of demographic variables. Chi-squared test was used for the difference analysis for the categorical data, such as TNM and mode of presentation. P value ≤0.05 was significant.

Results: In total, 1373 patients were diagnosed with CRC during the period from March 2017 to March 2021. The pre-COVID group (2017-2020) included 1104 CRC patients, compared to 269 patients in the COVID one (2020-2021). The mean age was higher in the pre-COVID group (p = 0.001). There was a statistically significant increase in the proportion of cases presenting with T4 disease (p = 0.023) and metastatic disease (p = 0.032) in the COVID group compared to the pre-COVID group. There was also a significant increase in the rate of emergency presentations (p < 0.0001).

Conclusion: We observed a statistically significant increase in rates of locally advanced (T4) and metastatic (distant) CRC in patients presenting after introducing the COVID-19 lockdown. There was also an increase in emergency presentations. There was no observed difference in nodal status. This may reflect disruption to cancer diagnostic services and the reluctance of patients to access medical care during a pandemic, particularly the elderly.

Keywords: colorectal cancer (crc); coronavirus; covid-19; emergency presentation; staging.