The Impact of COVID-19 on the Colorectal Cancer Pathway

The UK’s effective pathway for the early detection, diagnosis and treatment of cancer that is essential to achieving a favorable outcome has been damaged by the onset of COVID-19. The restrictions put in place to protect individuals from the pandemic has resulted in delays in accessing cancer services. Recent data estimation studies have predicted that COVID-19 will result in at least a 15% increase in cancer-related deaths. In the first study using real data of colorectal patients – which accounts for the second largest cause of cancer related deaths in the UK has begun to highlight the scale and severity of the issue.

Colonoscopies and the subsequent histopathological analysis of the biopsy is the main diagnostic tool in colorectal cancer. A patient diagnosed at stage I has a 90% survival rate at 5 years. If diagnosed at stage IV, the survival rate at 5 years plummets to 10%. The number of colonoscopy procedures dropped by 92% from Feb to April 2020. That’s 42,860 less colonoscopies taking place in the first few weeks of the pandemic. The number of average monthly colonoscopies performed recovered slowly and approached 2019 levels by October 2020. However, this suggests that at least 3,500 colorectal cancer diagnosis have been missed during the period between March and October 2020.

As the January 2021 lockdown came into force in addition to seasonal pressures, hospitals were keen to ensure cancer services operated at a near normal level wherever possible. This was challenging due to shortages of resources including staff and PPE but also the need to offer care in a COVID-19 safe manner. Extra capacity was created with extra clinics, but the number of patients seen only returned to levels seen in 2019 and not greater than you would expect if the backlog was being reduced. Only constant monitoring and analysis of patients will reveal if the backlog has affected a proportion of patients early on in their journey at the start of the pandemic or if it is continuing to prevent early presentation.

It appears that there are now instances of undiagnosed cancer which will be more severe at presentation. As the scale of the damage done to cancer pathways are assessed, efforts are underway to address the backlog of patients requiring diagnosis. But increasing capacity in an already overwhelmed system is challenging. Vital to diagnosis is the microscopic examination of tissue retrieved at colonoscopy. Pre COVID-19, histopathology was a declining specialty, facing difficulties in staffing as the ageing workforce of specialist doctors needed for the diagnosis retired. Now, in the same way that the private hospitals of the UK have banded together with the NHS to fight COVID-19, it is right that private partners such as Source Bioscience are at the forefront of achieving results for patients awaiting a histopathological diagnosis. 

If you would like to find out more about Source BioScience histopathology services contact us today or call us on +44 (0) 115 973 9012.

References: 

Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00005-4/fulltext