SP4.1.7 Colorectal Cancer: Pathway Disruptions as a Result of COVID-19

Abstract Aims COVID-19 has impacted diagnosis and treatment of colorectal cancer. Efforts to minimise patient contact have caused delays in cancer pathways, generating a potential risk to patient care. We aim to identify the pandemic effect on colorectal referral pathways. Methods All cancer referrals during March-June 2020 were reviewed to obtain information on the timeline and planning of investigation and treatment. The data was compared to evidence from the same referral period in 2019. Results 681 referrals were received during March-June 2020, compared to 1032 in 2019, indicating a 34% decrease. The majority of patients were reviewed in telephone clinic (76.2%) rather than physical appointments (15.4%). Although the commonest mode of investigation was endoscopy(46.2%), there was increased use of CT scan(35.8%). 114(17.1%) patients were not investigated, of which 40(35.1%) declined investigation, primarily due to COVID-19 apprehension. 6 patients were re-referred and 67(58.8%) were removed from the pathway for unknown reasons. 1 patient was subsequently admitted as an emergency. There were 44 new diagnoses of colorectal cancer based on MDT discussion, of which 14(31.8%) breached the investigation and 20(45.5%) the treatment date. 18 underwent curative surgery compared to 47 in the same period in 2019, indicating 61.7% less operative activity. Conclusions COVID-19 has changed surgical practice, forcing alternative clinic, investigation and treatment methods. Disruption of colorectal pathways is causing reduced referrals, investigation delays and less surgical activity. Delayed presentation with advanced disease may deprive the opportunity of treatment with curative intent.

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Nutritional status and outcomes of veterans undergoing curative surgery for colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18585 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18585-e18585

Author(s):

Urvashi Mitbander ◽

Timothy Frankel ◽

Irina Y. Dobrosotskaya

Keyword(s):

Colorectal Cancer ◽

Weight Loss ◽

Tertiary Care ◽

Veterans Health ◽

Health Administration ◽

Significant Weight Loss ◽

Curative Surgery ◽

Curative Intent ◽

Post Surgery ◽

One Year

e18585 Background: Malnutrition is highly prevalent within the cancer population. Malnourishment has various negative surgical and oncologic impacts. The Veterans Health Administration (VHA) provides comprehensive care to patients in a single-payer system allowing for capture of peri-operative data and the opportunity for focused pre-operative (pre-op) interventions to improve outcomes. We sought to study the effect of pre-op weight and albumin on post-operative (post-op) complications in a contemporaneous group of veterans with colorectal cancer (CRC) at a tertiary care Veterans Affairs (VA) hospital. Methods: This is a retrospective review of 105 patients with colorectal malignancies treated with curative intent surgery at the VA Ann Arbor Healthcare System between January 2015 and January 2020. Patients with distant metastatic disease, neoadjuvant therapy, non-adenocarcinoma histology, or those receiving majority of care outside of the VHA were excluded. We examined BMI trends from one year prior to one year post surgery, rates of nutrition consults, and post-op complications defined as abnormal clinical developments such as, but not limited to, infection and delayed wound healing. Fisher’s exact test was used for analysis. Results: At time of CRC diagnosis, the mean age was 70.3 ± 9.1 and the median stage was T2N0. Surgical resections were 65% (n = 68) laparoscopic. Pre-op weight loss from 6 months prior to diagnosis to time of surgery was observed in the majority of patients (n = 47, 64%). Significant weight loss, defined as ≥3% weight reduction, was seen in 45% (n = 33) of patients. A quarter of patients were identified to have a low pre-op albumin of less than 3.5 (n = 25, 25%). Significant weight loss and low pre-op albumin were each independently associated with increased post-op complications (p < 0.01). Post-op weight loss was seen in 81% (n = 73) and 69% (n = 48) of patients at 30- and 60-days post-op, respectively, and was not associated with post-op complications. Inpatient post-op nutrition consultation was performed in 96% (n = 101) of patients; nutritional supplements were recommended in only 23% (n = 23) of cases. In patients with significant weight loss, pre-op nutrition evaluation was performed in 15% (n = 5) of cases and post-op outpatient nutrition follow up occurred in 18% (n = 6) of cases. Conclusions: 45% of patients had ≥3% weight loss 6 months prior to diagnosis of CRC and 25% of patients had low albumin levels. These led to greater post-operative complications. An intensive nutrition pre-habilitation program to address weight loss and low albumin prior to surgery for CRC is needed and may reduce associated complications.

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Interhospital referral of colorectal cancer patients: a Dutch population-based study

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03881-2 ◽

2021 ◽

Author(s):

A. K. Warps ◽

◽

M. P. M. de Neree tot Babberich ◽

E. Dekker ◽

M. W. J. M. Wouters ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Waiting Time ◽

Secondary Care ◽

Advanced Disease ◽

Waiting Times ◽

Tertiary Care ◽

Disease Stage ◽

Colorectal Cancer Patients ◽

Tertiary Care Hospitals

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

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Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer

Indian Journal of Surgery ◽

10.1007/s12262-021-02848-5 ◽

2021 ◽

Author(s):

Franz Xaver Singhartinger ◽

Martin Varga ◽

Tarkan Jäger ◽

Adam Dinnewitzer ◽

Oliver Koch ◽

...

Keyword(s):

Colorectal Cancer ◽

Lung Metastases ◽

Primary Tumour ◽

Median Number ◽

R0 Resection ◽

Curative Intent ◽

Median Hospital Stay ◽

Free Survival ◽

Colorectal Cancer Patients ◽

Primary Tumour Site

Abstract Background Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. Methods This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Results Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Conclusion Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

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Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02207-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Inge van den Berg ◽

Robert R. J. Coebergh van den Braak ◽

Jeroen L. A. van Vugt ◽

Jan N. M. Ijzermans ◽

Stefan Buettner

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Multicenter Study ◽

Survival Data ◽

Standard Therapy ◽

Tumor Grade ◽

National Registry ◽

Stage I ◽

Stage Iii ◽

Curative Intent

Abstract Background Colorectal cancer is the third most common type of cancer in the world. We characterize a cohort of patients who survived up to 5 years without recurrence and identify factors predicting the probability of cure. Methods We analyzed data of patients who underwent curative intent surgery for stage I–III CRC between 2007 and 2012 and who had had been included in a large multicenter study in the Netherlands. Cure was defined as 5-year survival without recurrence. Survival data were retrieved from a national registry. Results Analysis of data of 754 patients revealed a cure rate of 65% (n = 490). Patients with stage I disease and T1- and N0-tumor had the highest probability of cure (94%, 95% and 90%, respectively). Those with a T4-tumor or N2-tumor had the lowest probability of cure (62% and 50%, respectively). A peak in the mortality rate for older patients early in follow-up suggests early excess mortality as an explanation. A similar trend was observed for stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections. Patients with stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections show a similar trend for decrease in CSS deaths over time. Conclusion In the studied cohort, the probability of cure for patients with stage I–III CRC ranged from 50 to 95%. Even though most patients will be cured from CRC with standard therapy, standard therapy is insufficient for those with poor prognostic factors, such as high T- and N-stage and poor differentiation grade.

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