The impact of the first peak of the COVID‐19 pandemic on colorectal cancer services in England and Wales: A national survey, by Boyle et al

Abstract

In this month s issue of Colorectal Disease, Boyle et al [1] report on the impact of COVID19 on colorectal cancer care during the first wave of the pandemic and highlight the key lessons learnt by institutions in the United Kingdom (UK). Combining regional variation in COVID19 rates and questionnaire data, the authors sought to explore the impact on units in terms of referrals, access to ‘cold’ sites, and changes to services. This study suggested that there were significant reductions in referrals during the first wave for colorectal cancer with significant departures from previous established management pathways. This led to delays in diagnostics, starting radiotherapy and delays or deferrals to surgery and management of distant disease. It is difficult to unpick the impact of delays on cancer survival. Data addressing this question are limited; mostly retrospective with multiple possible confounders. Despite these limitations, studies do suggest that delays in time from diagnosis to surgery in colon cancer does impact on survival [2]. Though UK outcomes from colon and rectal cancer have improved over time, survival does not compare favourably with many other similar countries [3]. It may be argued that such differences may reflect population as well as data collection variation. Irrespective of this, the delays encountered over the last year will contribute to poorer survival from colorectal cancer in the future and may exaggerate international differences and negate our hard won gains. During the first and second surges of the COVID19 pandemic, it is not only cancer care that has been affected. Colorectal surgery as a whole has been significantly impacted. Colorectal cancer services have largely been prioritised with many patients with benign disease being medically managed or experiencing long delays. These delays have been due to a combination of fears around the safety of surgery in areas with high COVID19 rates and alternations to surgery management such as an ‘abundance of caution’ around the use of laparoscopy. Prioritisation and rationalisation of care in the face of limited critical care support have played a large part. In the short term this was necessary to divert staff to manage COVID19 patients in the pandemic but in the medium and longer term, this unwanted side effect has led to untold harm amongst these patients. The waiting lists will take years to remedy in the context of reduced capacity with a workforce suffering from burnout and low morale [4]. Patients will experience disease progression, pain, poorer quality of life and increased emergency presentations. Unfortunately, it is likely that COVID19 will continue to have deleterious effect on services for years to come both in terms of the legacy of the last year but also the result of subsequent surges in the virus. The lessons learnt from the first wave, as outlined by Ms Boyle and colleagues, are essential to plan for the next wave [1]. The key elements identified were adequate triage, communication and coordination, establishment of ‘cold’ sites and use of virtual systems for communications. With a rise in case numbers, urgent action is needed to put robust measures in place to minimise delays for colorectal cancer patients but also address the backlogs for patients with benign disease.