Effect of COVID-19 Pandemic on Colorectal Cancer Diagnosis, Treatment, and Outcomes

390487 08: (FILE PHOTO) A doctor goes over a patient”s x-ray, screening for colon cancer. There is no single cause of colon cancer. Cancer of the colon and rectum accounts for 15% of cancer deaths. (Photo by American Cancer Society/Getty Images)
Researchers examined short-term outcomes of patients with colorectal cancer during the first wave of the COVID-19 pandemic in Sweden.

Colorectal cancer (CRC) diagnosis, treatment, and outcomes largely remained unaffected by the COVID-19 pandemic in Sweden, with the exception of an increase in the number of ostomy formations and decreased resident surgeon participation, according to study findings published in JAMA Network Open.

Researchers conducted an observational, population-based, cohort study comparing prepandemic treatment outcomes of 590 patients diagnosed with CRC between March and August 2019 to treatment outcomes of 550 patients with CRC during the height of the COVID-19 pandemic, from March to August 2020 in Stockholm, Sweden.

During the first wave of the COVID-19 pandemic, 6.7% fewer cases of CRC were diagnosed. Patients diagnosed with CRC during the height of the COVID-19 pandemic exhibited more advanced T-stage disease compared with prepandemic patients (T4 stage: 30% vs 22%; P <.001). In 2020, clinicians diagnosed fewer patients with NO stage disease compared with those in 2019 (41% vs. 46%; P =.02), with a corresponding increase of patients who had stage Nx disease.

Similar rates of metastasis (21% vs 21%), plans for surgical interventions (84% vs 81%), and actual surgical interventions (77% vs. 73%) occurred both years. Notably, resident surgeons participated less in resections during 2020 compared with 2019 (27% vs. 35%), which potentially resulted from emergency redistribution of medical care to COVID ICUs.

Use of ostomies over anastomoses almost doubled in patients with colon cancer from 17% in 2019 to 30% in 2020 (absolute risk difference, 13%; 95% CI, 6.8%-20%) to minimize postoperative complications and decrease burden of care in ICUs, which were overwhelmed during the height of the COVID-19 pandemic. Despite efforts to reduce postoperative complications, patient length of stay in the ICU, and need for reoperation within 30 days, these outcomes remained unchanged during the pandemic compared with prepandemic outcomes.

“Many countries developed new recommendations for the management of [CRC] during the pandemic,” the study authors noted. “In Sweden, the temporary guidelines for the treatment of [CRC] aimed to maintain quality, to reduce the load on ICU care by minimizing complications, and to identify patients in need of urgent treatment.”

Study limitations included potential registration misclassification errors, potential underreporting of complications, and lack of information in the register.


Eklöv K, Nygren J, Bringman S, et al. Trends in treatment of colorectal cancer and short-term outcomes during the first wave of the COVID-19 pandemic in Sweden. JAMA Netw Open. Published online May 9, 2022. doi:10.1001/jamanetworkopen.2022.11065