Patient encounters and new diagnoses of gastrointestinal (GI) cancers and procedures significantly declined in 2020 during the coronavirus disease 2019 (COVID-19) pandemic compared with a similar period in 2019, according to a study in Gastroenterology.
Investigators used a global health research network to retrospectively analyze data from multiple US health care organizations (HCOs) and estimated the change in the number of patients who had healthcare encounters, procedures, and diagnoses of new GI cancers from early in the pandemic (March 15, 2020, to July 15, 2020), compared with the same period in 2019 (March 15, 2019, to July 15, 2019). The number of patients with procedures and new diagnoses of GI cancers was calculated per 100,000 patients with healthcare encounters. The study authors then assessed the trend later in the pandemic (July 16, 2020, to November 15, 2020), compared with the same period in 2019.
From March 15, 2019, to July 15, 2019, a total of 8,661,314 adults had at least 1 healthcare encounter reported in 41 HCOs. During the early period of the COVID-19 pandemic, 6,264,995 patients had at least 1 healthcare encounter reported in 36 HCOs, which resulted in an estimated decline in inpatient (–42.99%), emergency department (–40.09%), and ambulatory (–22.55%) visits. Virtual visits (+4465.02%) per HCO increased during the early pandemic phase compared with the same period in 2019.
The researchers observed a decrease in patients who underwent endoscopy (71.84%), colonoscopy (84.66%), abdominal ultrasound (35.78%), endoscopic ultrasound (73.15%), and endoscopic retrograde cholangiopancreatography (48.79%) in the early pandemic period.
Sensitivity analysis demonstrated a substantial decline in new diagnoses of GI cancers during the early pandemic period compared with a similar period in 2016, 2017, and 2018. In addition, a decrease in patient visits, procedures, and new diagnoses of cancers was also observed in the later phase of the pandemic compared with a similar period in 2019, although the proportion of decline was smaller compared with the early pandemic period.
The decrease in new diagnoses of malignant liver and intrahepatic (25.58%), colorectal (11.74%), esophageal and gastric (19.78%), and pancreatobiliary (15.56%) cancers later in the pandemic was considerable, but recovered, compared with the early period of the COVID-19 pandemic, according to the study authors.
“Patient encounters and new diagnoses of GI cancers and procedures significantly declined during the COVID-19 pandemic compared to a similar period in 2019,” the study authors commented. “These trends may result in an increase in late-stage cancer cases and poor cancer outcomes; moreover, the cancellation of cancer preventive GI procedures can lead to a rise in the incidence of GI cancers in the future.”
Although the number of virtual visits increased during the pandemic, this increase was not large enough to account for the decrease in volume of ambulatory visits, the investigators noted.
This study has several limitations. The data derived from the administrative coding systems is limited by miscoding or data entry errors. Additionally, this study estimated procedures and diagnoses only among the patients with healthcare encounters and did not account for patients without healthcare encounters.
“This [study] highlights the serious future implications that can result in an increased restraint on healthcare resources and lead to increased morbidity and mortality,” the researchers concluded. “Urgent policy and practice interventions will be needed, and healthcare organizations and gastroenterologists will need to use innovative methods to meet the backlog of screening and diagnostic tests for GI cancers.”
Khan A, Bilal M, Morrow V, et al. Impact of COVID-19 pandemic on gastrointestinal procedures and cancers in the United States. a multicenter research network study. Gastroenterol. Published online March 1, 2021. doi: 10.1053/j.gastro.2021.02.055