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Disparate Impact of the COVID Pandemic on Delays in Colorectal Cancer Treatment: A National Cancer Database Study
Sophie H. Chung MD
1, Gordana Rasic MD MS
1, Kelsey S. Romatoski MD
1, Kelly Kenzik MS PhD
1, Jennifer F. Tseng MD MPH
1, Teviah E. Sachs MD MPH
1 1Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
Background: Timely treatment for colorectal cancer (CRC) patients may have been disrupted by the COVID pandemic. We evaluated the impact of the pandemic on delays to treatment with surgery or systemic therapy for CRC patients and delineated factors predictive of delayed treatment.
Methods: Using the National Cancer Database, patients diagnosed with CRC were categorized by year of diagnosis as COVID-era (2020) versus pre-COVID (2018-2019). Categorical variables were compared by chi-square analysis. Multivariate logistic regression was used to assess odds ratios for delayed time to surgery (DTS) or chemoimmunotherapy (DTC), defined as >60 days.
Results: 50,689 CRC patients were diagnosed pre-COVID vs. 21,331 COVID-era patients. Patients diagnosed during COVID had higher stage at diagnosis. There were no differences in the proportion of DTS for patients diagnosed in 2020, but patients that were tested for COVID had increased proportions of DTS. In multivariate analysis, Black race and uninsured/underinsured status were associated with DTS. Diagnosis during COVID did not increase DTC, regardless of COVID testing or positivity; however, delays were seen for Black, Hispanic, and uninsured/underinsured patients.
Conclusion: While the pandemic did not delay treatment for CRC overall, vulnerable and underserved populations were disproportionately affected by delays to all forms of therapy. The difference in population colorectal disease outcomes resulting from these delays in treatment may be seen in the coming years.
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