eP718 - The Impact of the COVID-19 Pandemic on Colorectal Cancer Patients: A Comparative Analysis

Purpose/Background: In March 2020, the coronavirus disease (COVID-19) was designated a global pandemic by the World Health Organization (WHO). As a recondite disease, it required reallocation of health care resources, impacting cancer screening programs. This led to a worldwide decline in preventive care services, which translated into treatment delay, a later stage of disease diagnosis, and increased mortality (1). Some studies showed 60%–100% decrease in colonoscopy cases early in the pandemic phase (2,3). Our aim is to evaluate the effect of the pandemic on colorectal cancer, hypothesizing a more advanced stage as a result of delay in treatment and diagnosis. As secondary end points, the study compares the demographics, comorbidities, surgical interventions, and rate of ostomy creation between both periods.Methods/Interventions: Retrospective data was gathered on patients from a high-volume, specialized colorectal clinic in the northern area of Puerto Rico. The NeoMed EHR database was used for data gathering of patient demographics, medical comorbidities, social risk factors, history of colonoscopy, intervention performed and pathology report of specimen. Additionally, pre-operative work-up was evaluated to determine stage of disease at time of diagnosis. Groups were divided into the "Pre-COVID group" (January, 2019– February, 2020) and the "COVID group" (March, 2020- April, 2021). Inclusion criteria were patients diagnosed with colorectal cancer during index period. Exclusion criteria included patients with colorectal cancer history and those treated prior to 2019. REDCap was used for data entry in cohorts for statistical analysis which included t-test and chi-squared test.Results/Outcomes: A total of 478 patients were included in the study [pre-COVID (PC) group: n=264; COVID (C) group: n=214)]. The most common age group in both cohorts was 61-80 yrs old (PC: 56%, C: 51.6%) with no gender differences observed. While most patients were overweight (BMI=25-29.9) in the “PC” group (37.5%), a normal BMI (19-24.9) distribution predominated in the “C” group (41.1%). The most common comorbidities among both groups were hypertension (PC: 56%, C: 58.9%; P=0.592), diabetes mellitus (PC: 29.9%, C: 28.8%; P=0.789) and hypothyroidism (PC: 17%, C: 26.6%; P=0.011). There was a statistically significant decrease in smoking status (PC: 17.8%, C: 10.3%; P=0.020) and alcohol intake (PC: 14.4%, C: 7.0%; P=0.21) during the pandemic as well as a decrease in proctectomies during this period (PC: 18.2%, C: 10.7%; P=0.023). When comparing the TNM stages for both groups, there was a 7% increased incidence in T3 tumors (PC: 35%, C: 45%; P=0.150). In terms of staging, there was an increased frequency of stage 1 (PC:19.3%, C:26.6%; P=0.057) and stage 3 (PC: 20.8%, C: 24%; P=0.366) disease. No statistically significant changes were observed when comparing rates of ostomy creation.Conclusion/

Discussion: The study suggests that continuous care was provided to newly diagnosed colon and rectal cancer patients during the pandemic. Contrary to our initial hypotheses, no statistically significant differences were seen in advanced stages at time of diagnosis, nor was access of care delayed to referred patients, with only a 50-patient difference among both periods . This could be related to alternative care protocols implemented, such as telemedicine, during the initial COVID-19 period which ensured continuity of care and treatment availability. This study highlights the importance of specialized centers during times of crisis to minimize deleterious effects on patient care.