Lesi Omotara Kafayat, Igho-Osagie Ebuwa, Walton Sarah-Jane
Mid and South Essex NHS Foundation Trust, Basildon and Thurrock University Hospitals, Essex, United Kingdom.
Tufts School of Medicine, Boston, MA, United States.
Ann Med Surg (Lond). 2022 Jan;73:103182. doi: 10.1016/j.amsu.2021.103182. Epub 2021 Dec 15.
Current NHS guidelines recommend that treatment of colorectal patients referred through the two-week wait referral system should occur within sixty two days from the date of referral. The COVID-19 pandemic which started in March 2020 has however led to significant delays in the delivery of health services, including colorectal cancer treatments. This study investigates the effects of delayed colorectal cancer treatments during the COVID pandemic on disease progression.
A retrospective chart review of 107 patients with histologically confirmed diagnosis of colorectal cancer was conducted. The occurrence of cancer upstaging after initial diagnosis was assessed and compared between patients with treatment delays and patients who received treatments within the period recommended by NHS guidelines. A logistic regression was performed to evaluate the association between treatment delays beyond 62 days and cancer upstaging.
The median age of the cohort was 71.2 years and 64.5% of the patients were over 65 years. Treatment delays were observed in 53.3% of reviewed patients. Patients with treatment delays received cancer treatments 95.8 (31.0) days on average after referral, compared to 46.3 (11.5) days in patients who experienced no treatment delays (p-value<0.0001). 38.6% of patients with treatment delays experienced cancer upstaging by the time of treatment, compared to 20% in the non-delay group (p-value = 0.036). Patients who received treatment after sixty two days from date of referral were 3.27 times more likely to experience colorectal cancer upstaging compared to those who received timely treatments.
Although an effective response to the Covid-19 pandemic requires the reallocation of healthcare resources, there is a need to ensure that treatments and health outcomes of patients with chronic diseases such as colorectal cancer continue to be prioritized and delivered in timely fashion.
英国国家医疗服务体系（NHS）现行指南建议，通过两周等待转诊系统转诊的结直肠癌患者应在转诊之日起62天内接受治疗。然而，始于2020年3月的新冠疫情导致包括结直肠癌治疗在内的医疗服务交付出现显著延迟。本研究调查了新冠疫情期间结直肠癌治疗延迟对疾病进展的影响。
对107例经组织学确诊为结直肠癌的患者进行回顾性病历审查。评估并比较了治疗延迟患者与在NHS指南推荐的时间内接受治疗的患者在初次诊断后癌症分期升级的情况。进行逻辑回归分析以评估超过62天的治疗延迟与癌症分期升级之间的关联。
该队列的中位年龄为71.2岁，64.5%的患者年龄超过65岁。在53.3%的审查患者中观察到治疗延迟。治疗延迟的患者在转诊后平均95.8（31.0）天接受癌症治疗，而未经历治疗延迟的患者为46.3（11.5）天（p值<0.0001）。38.6%的治疗延迟患者在治疗时出现癌症分期升级，而非延迟组为20%（p值 = 0.036）。与及时接受治疗的患者相比，从转诊日期起62天后接受治疗的患者结直肠癌分期升级的可能性高3.27倍。
尽管有效应对新冠疫情需要重新分配医疗资源，但有必要确保结直肠癌等慢性病患者的治疗和健康结果继续得到优先考虑并及时提供。
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