Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study.
Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study.
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DOI：
10.1016/s2468-1253(21)00005-4
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Baigent C
中科院分区：
文献类型：
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作者：
Morris EJA;Goldacre R;Spata E;Mafham M;Finan PJ;Shelton J;Richards M;Spencer K;Emberson J;Hollings S;Curnow P;Gair D;Sebag-Montefiore D;Cunningham C;Rutter MD;Nicholson BD;Rashbass J;Landray M;Collins R;Casadei B;Baigent C
有人担心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可以量化任何影响。本研究旨在探讨COVID-19大流行对英国结直肠癌检测和管理的影响。数据提取自四个基于人群的数据集，涵盖英国NHS（国家癌症等待时间监测、月度诊断、二次使用服务入院患者护理和国家放疗数据集），涵盖2019年1月1日至2020年10月31日期间与英国结直肠癌相关的所有转诊、结肠镜检查、外科手术和直肠放疗课程。调查了2019年至2020年期间护理模式的差异。计算了每月人数和比例减少的百分比。与2019年的月平均水平相比，2020年4月，疑似癌症的每月2周转诊次数减少了63% (95% CI 53-71)（从36 274例减少到13 440例），结肠镜检查次数减少了92% (95% CI 89-95)（从46 441例减少到3484例）。到2020年10月，数量才刚刚恢复。这导致转介治疗的病例数相对减少22% (95% CI 8-34)（从2019年的每月平均2781例转介到2020年4月的2158例转介）。到2020年10月，每月的发病率已恢复到2019年的水平，但没有超过2019年的水平，这表明，从2020年4月到10月，英国诊断和治疗结直肠癌的人数比预期减少了3500多人。与2019年的月平均水平相比，2020年4月接受手术的人数也相对减少了31% (95% CI 19-42)，腹腔镜手术的比例更低，造口手术的比例更高。到2020年10月，腹腔镜手术和造口率与2019年的水平相似。对于直肠癌，由于更多地使用短期方案，与2019年的月平均值相比，2020年4月新辅助放疗的使用相对增加了44% （95% CI 17-76）。尽管在2020年6月，短期方案的使用率有所下降，但直到2020年10月，使用率仍高于2019年的水平。COVID-19大流行导致转诊、诊断和治疗结直肠癌的人数持续减少。到2020年10月，护理路径目标的实现已恢复到2019年的水平，尽管患者数量有所减少，而且通常做法有所改变。由于第二波COVID-19， NHS的压力越来越大，需要采取紧急行动，解决英国未被发现和未经治疗的结直肠癌日益增加的负担。英国癌症研究所、医学研究委员会、英国公共卫生部、英国健康数据研究所、NHS数字化和国家健康研究所牛津生物医学研究中心。
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.