Impact of COVID-19 Pandemic on Management of Colorectal Cancer Patients in the Tertiary Care Hospital in Thailand

Background: The global healthcare systems have undergone significant changes due to the profound impact of the COVID-19 pandemic, leading to modifications in healthcare delivery, treatment protocols, patient access, and overall outcomes. Objective: To evaluate the influence of the COVID-19 pandemic on the management of colorectal cancer patients in Thailand. Materials and Methods: The present study was a retrospective cohort study conducted at a tertiary referral hospital, involving patients diagnosed with colorectal cancer who underwent curative surgery between January 1, 2018, and December 31, 2021. The study period was divided into two phases, pre-COVID-19 outbreak, which was 2018 and 2019, and during the COVID-19 outbreak, which was 2020 and 2021. Retrospective data collection focused on patient demographics, medical outcomes, and a comparative analysis between the pre-COVID and COVID-19 periods was conducted to assess the impact on colorectal cancer management and patient outcomes. Results: The number of patients studied was 413, showing no significant difference between both periods with 203 pre-COVID and 210 during COVID. During COVID-19, more colorectal cancer patients underwent emergency surgeries at 20% versus 11.3% (p=0.05) and had higher rates of advanced disease staging at 52.9% versus 40.9% (p=0.039) compared to pre-pandemic times. For rectal cancer, the COVID-19 led to prolonged surgery waiting times at 19 weeks versus 13 weeks (95% CI 2.40 to 9.73). This was potentially due to a higher number of patients receiving neoadjuvant treatment, including a larger proportion receiving total neoadjuvant treatment, which extended the overall treatment duration compared to conventional CCRT at 36 weeks versus 22 weeks (95% CI 10.23 to 17.92). Conclusion: The present study examined the impact of COVID-19 on treating colorectal cancer. The number of surgeries increased in advanced cancer staging, which is Stage III and IV, during the COVID-19 outbreak. This may be due to the reduction in cancer case screenings, leading to patients presenting with emergencies requiring more frequent emergency operations.