‘Higher Prevalence’ of Cancer is Consequence of Canceled Surgeries Amid Lockdowns: Study

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An estimated 10,000 patients canceled elective surgeries in 2020, researchers said.

Surgical operations for colorectal cancer dropped in the first year of the pandemic as screening and diagnosis declined due to COVID-19 restrictions and people’s fear of contracting the illness, according to a recent study.

The peer-reviewed study, published in the Journal of the American College of Surgeons on March 25, investigated how the COVID-19 pandemic impacted surgical interventions for colorectal cancer (CRC) in the United States. Researchers looked at data from the National Cancer Database (NCDB), analyzing adult patients who underwent surgical procedures for colon and rectal cancers in 2019 (pre-COVID) and 2020 (COVID). They found a 17.3 percent reduction in surgical operations among the over 105,000 patients in the initial year of the pandemic.

“The impact of the COVID-19 pandemic on colorectal cancer surgery transcends a mere decline in case numbers, resulting in a higher prevalence of patients with advanced disease,” the study said. “Patients who underwent surgery in 2020 displayed more advanced clinical and pathological tumor stages compared to those treated in 2019.”

“In cancer care, we are probably still seeing the tip of the iceberg, as the results of delayed screenings, diagnoses, and medical treatments could continue to present their bill in the future years.

Measures like social distancing implemented during the COVID-19 outbreak may have caused “unintended consequences, leading to increased mortality in the long term for other causes.”

“The reduced number of CRC screenings and delays in colonoscopies, with an estimated deficit of 3.8 million screenings for colorectal cancer in the U.S., is associated with the widespread avoidance of medical care due to the fear of contracting COVID-19.”

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Out of the 105,517 patients analyzed in the study, 83,128 underwent colon surgery while the remaining 22,389 were subjected to rectal surgery. Between 2019 and 2020, rectal cancer operations dropped by 21.1 percent while colon cancer operations declined 16.3 percent.

“As almost a fifth of patients did not undergo elective surgical procedures … the price we had to pay was also in the number of patients who had worse tumor stages on pathology,” the study said.

Patients operated on during the pandemic, uninsured individuals, and Medicaid beneficiaries were found to have “worse stage” colon and rectal cancer. “Individuals with lower incomes bore the burden of advanced colon cancer,” it said.

There were an estimated 10,000 patients who canceled elective surgeries in 2020, which the study said were “potentially the advanced colorectal tumors of 2021.”

Following the COVID-19 outbreak, the United States declared a national emergency and implemented measures to cut down interpersonal contacts and the spread of the virus.

Such strategies “profoundly impacted cancer care, reducing cancer screenings, diagnoses, and treatments,” the study stated. For instance, NCDB data recorded a 14.4 percent decline for all cancer patients in the first pandemic year.

“The COVID-19 pandemic also led to a decrease in the number of elective colorectal cancer (CRC) surgical cases throughout the world,” researchers wrote. It has been hypothesized that “the delay in surgical treatment of CRC may result in an additional loss of 10,043 lives in the U.S. over the next 5 years.”

Researchers called for more studies to understand the long-term consequences of delayed screenings, diagnoses, and treatments related to colorectal cancer.

The study was conducted by seven researchers from the United States and Italy. The researchers were from the Mayo Clinic in the United States, the University of Milan in Italy, and the University of Bologna in Italy.

COVID Effects on Cancer

The findings of the March 25 study have been confirmed by earlier analyses as well. According to the U.S. Centers for Disease Control and Prevention (CDC), “testing for breast, colorectal, and cervical cancer dropped more than 80 percent during the pandemic.”

“Screening numbers have improved, but many people are still overdue. Because of these missed screenings, many cancers will be found at a later stage, when they are harder to treat,” the agency said in February 2022. “Experts predict that 10,000 more people will die from breast and colorectal cancer alone due to screening delays.”

In an interview with Lisa Richardson, director of the CDC’s Division of Cancer Prevention and Control, April Donaldson, a cancer survivor who was diagnosed and treated for breast cancer during the height of the COVID-19 pandemic, recounted her harrowing experience.

“It really felt like trying to battle two monsters at the same time, and I couldn’t choose to ignore one while I fought the other one,” she said.

Ms. Richardson pointed out that she saw patients who wanted to delay treatment amid the pandemic. She advised them not to do so as the cancer could spread and make it harder to cure.

Ms. Donaldson agreed: “Cancer doesn’t wait and neither should you. Delaying treatments is risky. I encourage you to base your health care decisions on facts over fear. I also recommend that you listen to your body, get your recommended cancer screenings.”

A May 2021 study that investigated the impact of COVID-19 lockdowns on cancer care concluded there was a “substantial impact” from such measures, with the number of patient visits and treatments received declining between January and May 2020.
Another study from March 2022 conducted in France looked at how lockdowns contributed to post-traumatic stress disorder (PTSD) and anxiety in cancer patients.

It found that “the fear of coming to hospital because of the risk of contracting COVID-19 was the strongest predictor of PTSD.” Meanwhile, “fear of cancer recurrence appear to be the main predictor of anxiety.”

Researchers recommended that healthcare providers “should not prioritize COVID-19 over cancer as the latter remains a central concern for cancer patients.”

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