University of Leeds | January 2021 | Leeds Research: Thousands may have undiagnosed bowel cancer
Between April and October 2020, more than 3,500 fewer patients than expected were diagnosed with bowel cancer in England, finds a study by experts at the University of Leeds. Theirs is the first piece of research to assess the impact of the COVID-19 pandemic on the diagnosis and management of bowel cancer in England.
The researchers assessed the patterns of referral for bowel cancer investigation, diagnosis and treatment within the English NHS between the beginning of January 2019 to the end of October 2020.
Their results showed that, compared with an average month in 2019, during April 2020 at the peak of the first wave of coronavirus:
- the monthly number of referrals by GPs to hospital clinics for investigation of possible bowel cancer reduced by almost two thirds ( 63 per cent)
- the number of colonoscopies performed fell by 92% (from 46 441 to 3 484); and
- the monthly number of people with confirmed bowel cancer referred for treatment fell by over a fifth (22 per cent, from 2,781 to 2,158), and the number of operations performed fell by a third (31 per cent from 2,003 to 1,378).
Co-author of the study, Dr Katie Spencer said: “As a result of the coronavirus pandemic first wave, the NHS National Bowel Cancer Screening Programme was paused, and surgical capacity to treat patients was limited.
“It is very concerning that the improvements we had been seeing because of the early detection of bowel cancer are likely to have been set back during this time, and we need to ensure that patients continue to come forward so we can keep making progress in fighting this disease.” (Source: University of Leeds)
Read the unabridged news release from the University of Leeds
Summary
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% reduction in the monthly number of 2-week referrals for suspected cancer and a 92% reduction in the number of colonoscopies. Numbers had just recovered by October, 2020. This resulted in a 22% 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% 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% 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 primary paper is available from The Lancet Gastroenterology & Hepatology
Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study
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