Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality.
Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality.
复制标题
DOI：
10.1016/j.cgh.2020.09.008
复制
发表时间：
2021-07-01
期刊：
影响因子：
--
通讯作者：
Laghi, Luigi
中科院分区：
文献类型：
--
作者：
Ricciardiello, Luigi;Ferrari, Clarissa;Laghi, Luigi
背景与目标：SARS-CoV-2 大流行对医疗保健产生了突然而巨大的影响。在意大利，自疫情爆发以来，结直肠癌（CRC）筛查项目已被强制暂停。我们的目的是评估筛查程序的延迟是否会影响结直肠癌筛查的结果。方法：我们建立了一个程序模型，考虑到结肠镜检查时间的延迟，并估计由于患者上期迁移对死亡率的影响。预期的 CRC 病例数是使用意大利筛查人群的数据计算的。通过荟萃分析方法评估了延迟结肠镜检查对 CRC 分期的影响以及分期对死亡率的影响。结果：延迟 0-3 个月，预计 74% 的 CRC 为 I-II 期，而延迟 4-6 个月，I-II 期将增加 2%，而 III-IV 期则相应减少 (P = .068)。与基线（0-3 个月）相比，中度（7-12 个月）和长时间（> 12 个月）延迟将导致晚期 CRC 显着增加（分别从 26% 增加到 29% 和 33%；分别为 P = .008 和 P < .001）。我们估计，当延迟从 0-3 个月延迟到 >12 个月时，死亡总数会显着增加 (+12.0%) (P= .005)，并且当将基线与 >12 个月进行比较时，按阶段划分的死亡率分布会发生显着变化 (P < .001)。结论：筛查延迟超过 4-6 个月将显着增加晚期 CRC 病例，如果持续超过 12 个月，死亡率也会显着增加。我们的数据强调，考虑到未来可能出现的 SARS-CoV-2 或其他流行病浪潮，需要重新组织针对 CRC 等高影响疾病的努力。
BACKGROUND & AIMS: The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed to evaluate whether screening procedure delays can affect the outcomes of CRC screening.METHODS: We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach.RESULTS: With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (P = .068). Compared to baseline (0-3 months), moderate (7-12 months) and long (> 12 months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; P = .008 and P < .001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (P= .005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (P < .001).CONCLUSIONS: Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.