The coronavirus disease 2019 (COVID-19) pandemic has caused a substantial decrease in endoscopy services in Hong Kong, which has been associated with significant delays in the diagnosis of gastrointestinal (GI) cancer, according to a report published in Gastroenterology.
The COVID-19 pandemic has led to serious disruptions in the healthcare systems of many countries. However, the practical implications of service reductions remain unclear. In this study, researchers quantified the short-term disruption brought on by the COVID-19 pandemic on the delivery of GI endoscopy and its effect on cancer diagnosis and staging at a population level in Hong Kong.
Between January 23 and March 8, a total of 1045 COVID-19 cases were reported. Researchers determined the total number of upper and lower endoscopies performed in public hospitals in Hong Kong between October and March for the past 4 years using the Clinical Data Analysis and Reporting System (CDARS). Statistical measures such as Autoregressive integrated moving average (ARIMA) model, Buishand U test, linear regression model and state-transition Markov model were used to: predict the trend of patients newly diagnosed with gastrointestinal cancers; determine the week of turning point of the sudden changes; assess the relationship between the number of cancers diagnosed and the volume of endoscopy; and the potential stage shifting of these cancers with delayed diagnosis were estimated, respectively.
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During the first week of diagnosing new COVID-19 cases, The Buishand U test showed a turning point in the number of upper and lower endoscopies performed (P <0.001) and the number of gastric and colorectal cancers diagnosed (P <0.001). Subsequently, the average number of upper and lower endoscopies performed per week fell by 51.0% (from 1813 to 887, P <0.001) and 58.8% (from 1190 to 491, P <0.001), respectively. Additionally, the average number of gastrointestinal cancers diagnosed per week also dropped by 46.2% (from 22.9 to 12.3, P <0.001) and 37.0% (from 92.1 to 58, P <0.001), respectively. The ARIMA prediction and Markov model estimate that 4.6% and 6.4% of gastric and colorectal patients would have cancer stage upshifting at 6 months.
The authors state that, “the delay and subsequent cancer stage upshifting will be amplified if the COVID-19 pandemic lengthens further. Gradual resumption of non-emergency endoscopy services should be considered as early as feasible and practical, balancing the risks of delayed cancer diagnosis and personal safety of patients and staff.”
Reference
Lui, TKL, Leung K, Guo C, Tsui VWM, Wu JT, Leung WK. Impacts of COVID-19 pandemic on gastrointestinal endoscopy volume and diagnosis of gastric and colorectal cancers: A population-based study [available online May 17, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.05.037
