Abstract
The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016–4 March 2020) and intra-pandemic (5 March 2020–1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.
Highlights
The first case of COVID-19 was reported in Alberta, Canada on 5 March 2020
After June 2020, some diagnostic activities were resumed, which explained a small rebound in the number of colorectal cancer (CRC) cases; the diagnoses did not return to expected volumes (644 average cases from 2016–2019; 20% difference)
The current analysis focused on the colonoscopy, a test undergone by the largest proportion of patients, occurring early in the diagnostic pathway
Summary
This study followed a retrospective cohort design. We identified two population-based cohorts for different aims of this work. Diagnostic pathways are a sequence of events from initial clinical presentation to a final diagnosis of cancer [13]. These events include associated diagnoses, tests, and procedures undergone prior to receiving a cancer diagnosis. We refer to these events as based cohorts for different aims of this work. The conceptual framework for this analysis was diagnostic pathways and intervals [13]
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