Clinical Staging of Colorectal Cancer Increased in Post–COVID-19 Period

Decreases in the number and availability of cancer screenings during the COVID-19 pandemic have led to the significant stage migration of initial diagnosis in colorectal cancer (CRC), according to a study published in The American Journal of Surgery. The study found more conclusive results when extending the time period past 6 months.

During the COVID-19 pandemic, patients with signs of malignancy delayed needed evaluations due to fear of spreading the virus, which led to the delay of diagnosis and treatment of cancer. Favorable treatment response is reliant on early detection and diagnosis of cancer. Documentation on how the COVID-19 pandemic affected the degree of cancer disease at staging is limited. This study aimed to evaluate pre– and post–COVID-19 data from a period of more than 20 months, including the initial wave of COVID-19 through to the omicron wave, with the goal of assessing the severity of cancer stages after the COVID-19 pandemic.

Large and small intestine. Colon cancer, bacteria, inflammation, ulcerative colitis, colonoscopy, diverticulosis and diverticulitis, colon polyps. doctor isolated on dark background | Image credit: Tom - stock.adobe.com

All patients with diagnosed CRC at the Baptist Hospital South Florida/Miami Cancer Institute (BHSF/MCI) who had their first-course therapy at BHSF/MCI were included, and they were separated into pre– and post–COVID-19 groups. Data were also extracted from the MCI's Cancer Data Registry.

The pre– (May 1, 2018, to February 29, 2020) and post–COVID-19 (April 1, 2020, to January 31, 2022) periods extended for 22 months each. All diagnoses in March 2020 were not included due to that period being classified as the start of the pandemic. Secondary comparisons that included periods of 12 months before and after the pandemic were also completed to evaluate the possible staging value increases. Patients with primary cancer, malignant breast cancer, or melanoma during this time period were also included for evaluating the relationship of diagnosing and the pandemic. This included 2168 patients who had a clinical stage value of 0 to 4 and 2655 patients who had a pathological stage value of 0 to 4. The 2 groups were compared and analyzed.

There were statistically significant decrease between patients who received a CRC diagnosis at clinical stage T1 in the 22 months before and the 22 months after pandemic (–8.73%) and between those with CRC at clinical stage 0 (–2.80%). However, there was a statistically significant increase between patients with CRC clinical stage T4 (12.67%).

When evaluating patients who received their diagnosis in the 12 months pre– and post COVID-19, similar results were found. There was a statistically significant increase between those who received a diagnosis at clinical stage N2 (6.61%).

In the related findings from the patients who had breast cancer and melanoma, there were no significant findings in melanoma diagnoses in the 22 months pre– and post COVID-19 and in breast cancer diagnoses in the 12 months pre– and post COVID-19. However, there was an increase in the patients with breast cancer diagnosed at clinical stage T2 in the 22 months pre– and post COVID-19 (4.24%) and a decrease among those with pathological stage 2 (–2.21%) disease. Similarly, there was an increase in melanoma cancer diagnoses at stage T1 in the 12 months pre– and post COVID-19 (28.70%).

There were limitations to this study. It was conducted at a single center in Florida, which may make it less representative of other centers in the country, and the socioeconomic factors of the patients could make these findings less applicable to other locations. Also, clinical and pathological staging data were excluded due to the way the data were extracted, and there could have been other factors that influenced the results of the study outside of the pandemic.

The researchers concluded that the COVID-19 pandemic led to the decrease of screening for multiple cancers, with significant differences in stage migration in CRC at the 12- and 22-month marks. Their results suggest that “stage migration of CRC at initial diagnosis is becoming more distinguished over time, and thus the development of these trends should continue to be investigated,” the authors concluded.

Reference

Hanuschak D, DePiero M, DeMoraes M, et al. The impact of COVID-19 on patients diagnosed with melanoma, breat, and colorectal cancer. Am J Surg. Published online September 28, 2023. doi:10.1016/j.amjsurg.2023.09.040