DISPARATE IMPACT OF THE COVID-19 PANDEMIC ON DELAYS IN COLORECTAL CANCER TREATMENT
Sophie H. Chung*1,2, Kelsey S. Romatoski1, Gordana Rasic1, Kelly Kenzik1, Sing Chau Ng1, Jennifer F. Tseng1, Teviah Sachs1
1Surgery, Boston University School of Medicine, Boston, MA; 2University of California San Diego, La Jolla, CA
BACKGROUND: Adherence to current recommendations for the optimal time from diagnosis to treatment for patients with colorectal cancer (CRC) may have been disrupted by the COVID-19 pandemic. This study aimed to evaluate the impact of the pandemic on time to surgery or systemic therapy for patients diagnosed with colorectal cancer and delineate factors predictive of delayed treatment.
METHODS: Using the National Cancer Database, patients diagnosed with CRC were categorized based on year of diagnosis as COVID (2020) versus Pre-COVID (2018-2019). Sub-analyses were performed for patients who were tested for COVID-19 as well as those who had a positive COVID-19 result in 2020. Categorical variables were compared by chi-square analysis. Multivariate regression was used to control for confounding and assess odds ratios for delayed time to initial treatment (defined as greater than 60 days) for surgery or systemic treatment with chemotherapy or immunotherapy. Further subgroup analysis was performed to assess odds ratios for delayed treatment for patients who were tested for COVID or had a COVID-positive result.
RESULTS: 57,676 patients were diagnosed with CRC pre-COVID compared to 24,149 during COVID; 11,426 (47.3%) received COVID-19 testing and 803 (7.0%) had a positive COVID result. A larger proportion of patients diagnosed during COVID were Asian or other non-white/Black race; Hispanic; resided in the South or West; were uninsured, on Medicaid or Government insurance; and had higher stage at diagnosis. Proportions of delay to surgery (> 60 days) were comparable for patients diagnosed in 2020 (12.7%) compared to pre-COVID (13.2%), but higher for patients who were tested for COVID (15.6%) or COVID-positive in 2020 (17.8%). In a multivariate analysis controlling for patient demographics and year of diagnosis, diagnosis during COVID was not associated with delay to surgery, but COVID testing and positivity were. Delay to surgery was also associated with male sex, Black race, residence in the West or South, uninsured/Medicaid/Government insurance, or Stage 0-3 at diagnosis. Diagnosis during COVID did not increase delays to systemic therapy, regardless of COVID testing or positivity. However, the following characteristics were associated with delay to systemic therapy: any non-white race, Hispanic ethnicity, residence in the West or South, uninsured/Medicaid/Government insurance status, and stage 0-3.
DISCUSSION: While the COVID-19 pandemic did not delay treatment for CRC overall, COVID tested or COVID positive patients had increased delays to surgery compared to pre-COVID. Vulnerable and underserved populations were disproportionately affected by delays to surgery and systemic therapy. The difference in population colorectal disease outcomes mediated by these delays in treatment are yet to be realized.
Risk Associations for Delay to Surgery in the COVID versus non-COVID era using multivariate logistic regression. *Stages 0-1 combined due to low numbers.
Risk Associations for Delay to Systemic Treatment in the COVID versus non-COVID era using multivariate logistic regression. *Stages 0-1 combined due to low numbers.
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