Bárbara Abreu, Cristiana Sequeira, Tânia Gago, Cristina Teixeira, Pierre Lahmek, Marine Besnard, BrunoLesgourgues, Maria Ana Rafael. Portugal, France.
This is a Portuguese substudy of the French retrospective multicentric study ETICC (Etude de l’Impact de la pandémie COVID-19 sur le diagnostic et la prise en charge du Cancer Colorectal) coordinated by the Association Nationale des Gastroentérologues des Hôpitaux Généraux.The French study included 11 centers, with a total of 961 patients. In Portugal, 4 centers were included.
Patients included in the control group had a diagnosis of CRC made between the 1st January 2019 and the 29th February 2020 and patients included in the COVID group had a diagnosis performed between the 1st March 2020 and the 28th February 2021.
Data were collected regarding patient’s characteristics and tumor’s characteristics. Dates of first medical consultation concerning CRC, histological diagnosis, surgical resection, neodjuvant treatment, adjuvant or palliative chemotherapy were also collected. It was registered if there was a perception of a delay in the diagnosis or treatment of the CRC. To compare the “control” and “COVID” groups, non-parametric tests were used to compare quantitative variables and chi-square and the conditional independence Mantel–Haenszel test were used to compare qualitative variables.
Results
We included 766 patients, 496 in the control group and 270 in the COVID group, with similar median ages (70 years-old, IQR 58-82) and sex distribution (60% men) between groups. Concerning the staging of the CRC at the time of diagnosis, no statistically difference was found between groups (p=0.770). In the control group 25% of patients were asymptomatic at the time of diagnosis, whereas in the COVID group only 8.4% were asymptomatic (p<0.001). There was also a significant decrease in diagnosis after a positive fecal immunochemical test (FIT): 20.8% in the control group and 11.3% in the COVID group (p=0.002). In France, no significant decrease in CRC diagnosis in asymptomatic patients was found. 31.7% and 41.1% of patients initiated their follow-up at the hospital after going to the emergency room in the control and COVID groups, respectively, and 53.6% and 48.5% after consulting their general practitioner (p=0.020). The rate of complications at the time of diagnosis has increased, but without statistically significance, from 17.8% in the control group to 23.7% in the COVID group (p=0.050). Abdominal occlusion was the principal complication. In France, there was no significant difference in the rate of all complications or abdominal occlusion at the time of diagnosis.
A delay in the diagnosis and management was inferred in 16.6% of patients in the control group and in 33.6% in the COVID group (p<0.001). Time between the beginning of symptoms and first medical consultation significantly increased, from a median of 50 days in the control group to 64 days in the COVID group (p<0.001). On the contrary, time between histological diagnosis and tumor resection has decreased from a median of 65 days in the control group to 39 days in the COVID group (p<0.001). Time between histological diagnosis and neodjuvant treatment was not statistically different, as well as time between histological diagnosis and palliative chemotherapy. Time from CRC resection and adjuvant treatment has significantly decreased from 54 days in the control group to 43 days in the COVID group (p=0.001). In France, the only statistically significant interval difference was between CRC histological diagnosis and resection, which, similarly to what happened in Portugal, has decreased from 29.5 in the control group to 23 days in the COVID group (p=0.013).