Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
Lancet Gastroenterol Hepatol. 2021 Mar;6(3):199-208. doi: 10.1016/S2468-1253(21)00005-4. Epub 2021 Jan 15.
There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England.
Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated.
As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020.
The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England.
Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.
人们担心 COVID-19 大流行对癌症治疗产生了负面影响，但几乎没有直接证据来量化任何影响。本研究旨在调查 COVID-19 大流行对英格兰结直肠癌的检测和管理的影响。
从 NHS 英格兰的四个基于人群的数据集（国家癌症癌症等待时间监测、每月诊断、二次使用服务入院患者护理和国家放射治疗数据集）中提取了从 2019 年 1 月 1 日至 2020 年 10 月 31 日期间与英格兰结直肠癌相关的所有转介、结肠镜检查、手术和直肠放疗疗程的数据。研究了 2019 年和 2020 年之间护理模式的差异。计算了每月数量和比例的百分比减少。
与 2019 年的每月平均水平相比，2020 年 4 月，疑似癌症的 2 周转介每月数量减少了 63%（95%CI 53-71）（从 36274 例减少到 13440 例），结肠镜检查数量减少了 92%（95%CI 89-95）（从 46441 例减少到 3484 例）。到 2020 年 10 月，数量已经恢复。这导致治疗转介的病例数量减少了 22%（95%CI 8-34）（从 2019 年每月平均 2781 例减少到 2020 年 4 月的 2158 例转介）。到 2020 年 10 月，每月发病率已恢复到 2019 年的水平，但并未超过该水平，这表明从 2020 年 4 月到 10 月，英格兰有超过 3500 人被诊断和治疗结直肠癌的人数减少了。2020 年 4 月接受手术的人数也相对减少了 31%（95%CI 19-42），与 2019 年相比，腹腔镜手术和造口术的比例较低，而形成造口术的比例较高。到 2020 年 10 月，腹腔镜手术和造口术的比例与 2019 年的水平相似。对于直肠癌，由于短程方案的使用增加，2020 年 4 月新辅助放疗的使用相对 2019 年每月平均水平增加了 44%（95%CI 17-76）。尽管 2020 年 6 月短程方案的使用有所下降，但直到 2020 年 10 月，该方案的使用率仍高于 2019 年的水平。
COVID-19 大流行导致转介、诊断和治疗结直肠癌的人数持续减少。到 2020 年 10 月，实现了护理途径目标，尽管患者数量减少，且常规实践有所修改，但已恢复到 2019 年的水平。由于 NHS 面临第二波 COVID-19 的压力，需要采取紧急行动来解决英格兰日益增长的结直肠癌未检出和未治疗的问题。
英国癌症研究中心、医学研究委员会、英国公共卫生署、英国健康数据研究署、NHS 数字和英国国家卫生研究院牛津生物医学研究中心。
