Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study,The Lancet Gastroenterology & Hepatology

当前位置： X-MOL 学术 › Gastroenterol. Hepatol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study
The Lancet Gastroenterology & Hepatology ( IF 30.9 ) Pub Date : 2021-01-15 , DOI: 10.1016/s2468-1253(21)00005-4
Eva J A Morris ₁ , Raphael Goldacre ₁ , Enti Spata ₂ , Marion Mafham ₁ , Paul J Finan ₃ , Jon Shelton ₄ , Mike Richards ₄ , Katie Spencer ₅ , Jonathan Emberson ₂ , Sam Hollings ₆ , Paula Curnow ₆ , Dominic Gair ₆ , David Sebag-Montefiore ₃ , Chris Cunningham ₇ , Matthew D Rutter ₈ , Brian D Nicholson ₉ , Jem Rashbass ₆ , Martin Landray ₁ , Rory Collins ₁ , Barbara Casadei ₁₀ , Colin Baigent ₂

Affiliation

Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.
Cancer Research UK, London, UK.
Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
NHS Digital, Leeds, UK.
Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
Population Health Sciences Institute, University of Newcastle, Newcastle, UK; Department of Gastroenterology, North Tees University Hospital NHS Trust, Stockton on Tees, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK.

Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

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.

中文翻译：

COVID-19 大流行对英格兰结直肠癌检测和管理的影响：一项基于人群的研究

背景

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。本研究旨在调查 COVID-19 大流行对英格兰结直肠癌检测和管理的影响。

方法

数据是从英格兰 NHS 的四个基于人群的数据集（国家癌症癌症等待时间监测、每月诊断、二次使用服务承认的患者护理和国家放射治疗数据集）中提取的，用于所有转诊、结肠镜检查、外科手术和直肠放射治疗过程2019年1月1日至2020年10月31日，与英格兰结直肠癌相关。对 2019 年至 2020 年护理模式的差异进行了调查。计算了每月人数和比例的减少百分比。

发现

与 2019 年的月平均值相比，2020 年 4 月，每月两周转诊疑似癌症的人数减少了 63% (95% CI 53–71)（从 36 274 例减少到 13 440 例），结肠镜检查次数减少 92% (95% CI 89–95)（从 46 441 例减少到 3484 例）。到 2020 年 10 月，数字刚刚恢复。这导致转诊治疗的病例数量相对减少了 22% (95% CI 8-34)（从 2019 年的月平均 2781 例减少到 2020 年 4 月的月平均 2158 例）。到 2020 年 10 月，月度发病率已恢复到 2019 年的水平，但没有超过，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少了 3500 多人。与 2019 年月平均值相比，2020 年 4 月接受手术的人数相对减少了 31% (95% CI 19-42)，腹腔镜手术的比例较低，造口形成手术的比例较高。到 2020 年 10 月，腹腔镜手术和造口率与 2019 年水平相似。对于直肠癌，由于更多地使用短程治疗方案，2020 年 4 月新辅助放疗的使用相对 2019 年的月平均值相对增加了 44% (95% CI 17-76)。尽管在 2020 年 6 月，短程治疗方案的使用有所下降，但直到 2020 年 10 月，使用率仍高于 2019 年的水平。

解释

COVID-19 大流行导致结直肠癌转诊、诊断和治疗的人数持续减少。到 2020 年 10 月，护理路径目标的实现已恢复到 2019 年的水平，尽管患者数量减少并且对常规做法进行了修改。随着第二波 COVID-19 给 NHS 带来的压力越来越大，英国需要采取紧急行动来解决未发现和未治疗的结直肠癌日益增加的负担。