The multifaceted impact of the COVID-19 pandemic on colorectal cancer care: a systematic review of management disruptions, stage migration, and survival outcomes
Abstract
Background: The COVID-19 pandemic caused a catastrophic disruption to global healthcare systems. For colorectal cancer (CRC), the world's third most prevalent cancer, the suspension of screening programs and reallocation of resources threatened to severely impact timely diagnosis and treatment, with pre-existing models predicting significant excess mortality from even short delays.
Objective: This systematic review aimed to assess the impact of the COVID-19 pandemic on the management strategies, treatment outcomes, and survival rates of patients with colorectal cancer.
Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed was performed for studies published from 2020 onwards. Eligible studies included those focusing on adult CRC patients and reporting on changes in care pathways or outcomes due to the pandemic. Data on diagnostic delays, treatment modifications, stage at presentation, and survival were extracted and synthesized narratively.
Results: The synthesis of results from the included studies revealed a cascade of negative consequences. There was a severe global reduction in CRC screening, with participation declining by 30-80% and colonoscopy volumes falling by up to 92%, leading to a pool of "missing" diagnoses. This resulted in a significant stage shift, with a higher proportion of patients presenting with advanced stage (e.g., Stage IV) and locally advanced tumors. Treatment protocols were modified, including…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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