Impact of COVID-19 Pandemic on the Diagnosis of Gastrointestinal Cancer

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has had a major impact every aspect of life all over the world with severe consequences. Demonstration of its effects in the field of healthcare is very important for countries to make future plans. This study aimed to evaluate the impact of COVID-19 pandemic on the number of gastrointestinal endoscopy procedures and resulting cancer detection rate at our center along with clinicopathological characteristics of the patients by comparing the pandemic period with the same time intervals of previous years. Ultimately, the study intended to better understand how pandemic changed attitudes of patients towards health, how individuals and healthcare centers behaved in response to such an extraordinary situation and whether they avoided seeking medical care. This was a retrospective and single-center study. The 6-month period from March 11 to September 11, 2020 (lockdown period) was compared with the same months of 2018 and 2019 (pre-pandemic period) in terms of the number of endoscopic procedures performed at our gastroenterology unit, malignancy detection rate and clinicopathological characteristics of patients. The data were analyzed using the SPSS Statistics 22.0 software package. A 33% reduction was observed in the number of endoscopic procedures during the pandemic compared to pre-pandemic years and the difference was significant (p<0.001). Despite the decrease in endoscopic activity, cancer detection increased during the pandemic (p=0.057). Male sex and age 65 years or older were non-significantly more common among patients diagnosed with cancer on endoscopic biopsy during the pandemic compared to the pre-pandemic era but the difference was non-significant (p=0.983, p=0.241)c. Patients diagnosed with cancer during the pandemic were more likely to present at an advanced stage. The most common cancers were those originating from the colon and rectum and adenocarcinoma was the most prevalent pathological diagnosis. The distributions of tumor location and pathological diagnosis of the patients were not significantly different among the years (p=0,494, p=0,849). In conclusion, a reduction was found in the overall number of endoscopic procedures during the lockdown as a result of both postponing elective endoscopies and the reluctance of patients to seek medical care due to fear of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the hospitals. However, despite the decrease in the number of procedures, cancer detection rate and the rate of admission at advanced stages were increased at a non-significant level.

Keywords

• COVID-19
• gastrointestinal endoscopy
• gastrointestinal cancer
• tumor stages
• tumor locations

References

1. Referans1. Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process. Gut, 2020. 69(6): p. 1010-1018. doi: 10.1136/gutjnl-2020-320953
2. Referans2. Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology, 2020. 159(1): p. 81-95. doi: 10.1053/j.gastro.2020.03.065
3. Referans3. Soetikno R, Teoh AYB, Kaltenbach T, Lau JYW, Asokkumar R. Prodigalidad PC, et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointestinal endoscopy, 2020. 92(1): p. 176-183. doi: 10.1016/j.gie.2020.03.3758
4. Referans4. Parasa S, Reddy N, Faigel DO, Repici A, Emura F, Sharma P. Global impact of the COVID-19 pandemic on endoscopy: an international survey of 252 centers from 55 countries. Gastroenterology, 2020. 159(4): p. 1579-1581. e5. doi: 10.1053/j.gastro.2020.06.009
5. Referans5. D’Ovidio V, Lucidi C, Bruno G, Miglioresi L, Lisi D, Emilio M, et al. Impact of COVID-19 pandemic on colorectal cancer screening program. Clinical colorectal cancer, 2021. 20(1): p. e5-e11. doi: 10.1016/j.clcc.2020.07.006
6. Referans6. Turkington RC, Lavery A, Donnelly D, Cairnduff V, McManus DT, Coleman HG. The impact of the covid-19 pandemic on barrett’s esophagus and esophagogastric cancer. Gastroenterology, 2021. 160(6): p. 2169-2171. e1. doi: 10.1053/j.gastro.2021.01.208
7. Referans7. He T, Maclsaac MB, Hume SJ, Thompson AJ, Schulberg JD. COVID-19 and its impact on endoscopy services: what is the threshold for missed malignant diagnosis? Gut, 2020. doi: 10.1136/gutjnl-2020-322769
8. Referans8. Rutter MD, Brookes M, Lee TJ, Rogers P, Sharp L. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut, 2021. 70(3): p. 537-543. doi: 10.1136/gutjnl-2020-322179

9. Referans9. Zhu L, Cai MY, Shi Q, Wang P, Li QL, Zhong YS, et al. Analysis of selective endoscopy results during the epidemic of coronavirus disease 2019 (COVID-19). Zhonghua wei chang wai ke za zhi= Chinese journal of gastrointestinal surgery, 2020. 23(4): p. 327-331. doi: 10.3760/cma.j.issn.1671-0274.2020-0316-00147
10. Referans10. Huang K, Zhao X, Chen X, Gao Y, Yu J, Wu L. Analysis of digestive endoscopic results during COVID-19. Journal of Translational Internal Medicine, 2021. 9(1): p. 38. doi: 10.2478/jtim-2021-0006
11. Referans11. Morris EJ, Goldacre R, Spata E, Mafham M, Finan PJ, Shelton J, et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. The Lancet Gastroenterology & Hepatology, 2021. doi: 10.1016/S2468-1253(21)00005-4
12. Referans12. Mizuno R, Ganeko R, Takeuchi G, Mimura K, Nakahara H, Hashimoto K, et al. The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study. Annals of Medicine and Surgery, 2020. 60: p. 675-679. doi: 10.1016/j.amsu.2020.11.087
13. Referans13. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Pineros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International journal of cancer, 2019. 144(8): p. 1941-1953. doi: 10.1002/ijc.31937