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Colorectal

E110: COVID-19 Pandemic Impact on Disease Severity in Colon Cancer

    ePoster Abstract Author(s)

  • Queen Abure, B.S. (she/her/hers)

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

    • Submitter(s)

  • Queen Abure, B.S. (she/her/hers)

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

    • Author(s)

  • Queen Abure, B.S. (she/her/hers)

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • SS

    Siddharth Satuluru, B.S.

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • YR

    Yazmin Reategui, B.S.

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • Isabela Pavkov, B.S.

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • RP

    Raag Patel, B.S.

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • MF

    Mustafa Farooq, B.S.

    Medical Student
    Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

  • Tania Arora, MD, FACS, FSSO

    Associate Professor of General Surgery, Asisstant Dean of Learner Diversity, Equity, and Inclusion
    Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
    Augusta, Georgia, United States

  • DY

    Danny Yakoub, MD, PhD, FACS

    Chief of Surgical Oncology
    Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA, United States

Introduction: The COVID-19 pandemic was reported to be associated with a decline in median survival for colon cancer patients. Uncertainty exists whether this is attributed to disease severity escalation or delayed diagnosis and management.

Methods: This retrospective study analyzed the National Cancer Database (NCDB 2004-2020) data from 2018 to 2020, focusing on colon cancer patients. Descriptive statistics were used to compare time from diagnosis to initial treatment (days), AJCC (2017) TNM clinical stage distribution (S0-4), and pathological variables suggestive of tumor aggression between pre-pandemic and pandemic periods and withing Covid positive (C19+) and negative (C19-) patients. 

Results: Of the total cancers in the colon database 93.39% were adenocarcinoma, and 6.61% were classified as other. There was 25,861 patients (51.25% males) pre-pandemic (2018 & 2019), and 21,287 patients (52.10% males) in 2020 during the COVID-19 pandemic diagnosed with colon cancer. Overall, 2.83% of patients tested positive for COVID-19 during the pandemic. There was an increase in mean days to definitive surgery during the pandemic (46.4±68.4 Vs 40.2±63.3 prepandemic, p</span><0.001). Similarly, there was an increase in mean days to initial treatment in C19+ patients (27.85±51.82 Vs 23.91 ±30.4 in C19- patients, p</span> < 0.05). There was a significant increase in the percentage of patients with stage 4 disease in the pandemic (S0: 7.84%, S1:19.64%, S2: 9.91%, S3:6.73%, S4: 55.88%) compared to pre-pandemic (S0: 8.91%, S1: 20.78%, S2: 10.27%, S3:7.16%, S4:52.89%) (p = < 0.001). There was no difference in stage distribution between C19+ patients (S0: 8.46 %, S1:27.21%, S2:14.71%, S3:10.66%, S4:38.97%) & C19- patients (S0: 8.64%, S1: 27.31%, S2: 15.99%, S3: 10.56% S4: 37.50%) at the time of diagnosis. There was an increase in nodes positive/nodes harvested ratio in C19+ patients, mean of 0.178, in comparison to C19-, mean of 0.14, (p-value < 0.05) for patients diagnosed with stage 3 colon cancer during the pandemic. There were no significant differences in lympho-vascular invasion rates. 

Conclusions: COVID-19 pandemic caused significant delays in managing colon cancer patients. It was associated with increased proportion of advanced stage disease and increased positive lymph node ratio in S3 patients. There was no increase in stage distribution or severity in C19+ patients. Further data is awaited to comprehensively understand the interplay and long-term effects of different COVID-19 pandemic variables and colon cancer.

Learning Objectives:

  • Upon completion, participant will be able to analyze the impact of the COVID-19 pandemic on the time from colon cancer diagnosis to definitive surgery, considering both pre-pandemic and pandemic periods.
  • Upon completion, participant will be able to assess the changes in AJCC TNM clinical stage distribution in colon cancer patients during the COVID-19 pandemic.
  • Upon completion, participant will be able to evaluate the association between COVID-19 positivity and the ratio of positive lymph nodes to nodes harvested in stage 3 colon cancer patients