Supplementary Table 2.
Included Studies on Patient Delays in Care
| First author, year, design, dates | Country/setting/preprocedure testing | Endoscopy volume | Impact on cancer burden |
|---|---|---|---|
| Moraveji, 202037 Cross-sectional survey study May 2020 |
Unites States 407 respondents 276 centers (51% academic or university) Preprocedure testing: NR |
Procedure volumes 81% of centers reported >60% reduction for upper endoscopy 82% of centers reported >60% reduction for colonoscopy 71% of centers reported >60% reduction for deep enteroscopy |
NR |
| Lui, 202044 Multicenter, retrospective cohort, and modeling data October 1, 2019–March 31, 2020 |
Hong Kong All public hospitals Comparing procedure burden and cancer detection within similar time periods from 2017 to 2019 Preprocedure testing: NR |
Mean no. of upper endoscopies performed per week dropped by 51.0% (from 1813 to 887) Mean no. of lower endoscopies performed per week dropped 58.8% (from 1190 to 491) |
Mean gastric cancer and CRC diagnosed per week fell by 46.2% (from 22.9 to 12.3) and 37.0% (from 92.1 to 58), respectively. Based on the Markov model prediction: 4.6% of patients with gastric cancer and 6.4% of patients with CRC would have higher stage shifting at 6 mo. The proportion of stage IV cancers increased (gastric: 30.5% to 32.4%; and colorectal: 23.5% to 26.8%). |
| Markar, 202045 Multicenter retrospective cohort January 1, 2020–April 30, 2020 |
United Kingdom All hospital trusts (n = 122) Comparing procedures and cancer diagnoses for similar time period from 2019 Preprocedure testing: NR |
No. of diagnostic endoscopies was around 28% lower than in the same period in 2019 (149,043 vs 208,212) | Estimated no. of undiagnosed esophageal and gastric cancers was 750 across England, with a median of 47. 3 (IQR, 35. 7–57. 5) across cancer vanguards, or regions Estimated no. of undiagnosed esophageal and gastric cancers that would have been treated curatively was 213 across England, with a median of 11. 0 (IQR, 6.3–14.4) across cancer vanguards, or regions |
| Morris, 202147 Administrative population-based datasets January 2020–October 2020 |
United Kingdom NHS dataset Comparing colonoscopies, CRC diagnoses, and operations for 2 time periods from 2019 Preprocedure testing: NR |
No. of colonoscopies: April 2020: 92% reduction (95% CI 89- 95) from a mean of 46,441 colonoscopies to 3,484 colonoscopies. October 2020: 46,295 colonoscopies; similar to 2019 monthly average |
No. of confirmed CRC diagnoses: April 2020: 22% reduction (95% CI, 8–24) From 2781 individuals to 2158 individuals October 2020 similar to 2019 No. of monthly CRC operations: April 2020: 31% reduction (95% CI, 19–42) from mean of 2003 to 1378 October 2020: remained below 2019 monthly average Estimated that from April to October 2020, >3500 fewer people diagnosed and treated for CRC in England than would have been expected |
| London, 202051 Administrative population-based datasets January 1, 2020–April 30, 2020 Monthly data reported |
TriNetX Research Network UK and US institutions Comparing no. of patients with CRC for similar time period from 2019 Preprocedure testing: NR |
NR | No. of patients with CRC-related encounters: January 2020 −2.5% February 2020 −7.1% March 2020 −18.4% April 2020 −39.9% No. of patients with new CRC diagnoses: January 2020 7.8% February 2020 –6.7% March 2020 −16.3% April 2020 −54.2% |
| Lantinga, 202142 Retrospective cohort study March 15, 2020–May 15, 2020 (n = 9776) Compared with March 15, 2019–May 15, 2019 (n = 19,296) |
The Netherlands 20 Dutch hospitals (3 academic, 17 nonacademic) Comparing no. of endoscopies and cancers for a similar time period from 2019 Preprocedure testing: NR |
Endoscopic volume: EGD decreased by 57% (7846 to 4467), Colonoscopy decreased by 45% (12,219 to 5609) Stable endoscopic volume: ERCP (578 to 522) |
Endoscopy results identifying cancer decreased (524 to 340). Likelihood of detecting cancer during endoscopy increased from 2.7% in 2019 (95% CI, 2.5–3.0) vs 3.5% in 2020 (95% CI, 3.1–3.9; P < .001). |
| Pena-Rey, 202120 Retrospective observational study May 5, 2020–October 31, 2020 (n = 3310 colonoscopies) |
Spain Galician Programme for the Early Detection of Colon Cancer: Primary Care program affiliated with 7 hospitals performing endoscopy No preprocedure testing; only symptom screening |
Decrease in colonoscopy volume: 3310 in 2020 compared with 7491 in 2019 | NR |
| Rutter, 202148 Administrative population-based datasets (1) Pre-COVID period: January 6, 2020–March 15, 2020; n = 35,478 (2) Transition period: March 16, 2020–March 22, 2020; n = 4315 (3) COVID-impacted period: March 23, 2020–May 31, 2020; n = 6974 |
United Kingdom NHS dataset Comparing referrals of colonoscopies, CRC diagnosis, and operations for 2 time periods with pre-COVID period Preprocedure testing: NR |
(1) Pre-COVID 35,478 endoscopies performed per week (by 3007 endoscopists; mean 12 procedures per endoscopist) (2) Transition week: fell by one-third, to 23,827. (3) COVID-impacted period: 12% of the pre-COVID volume of procedures were conducted (average 4315/wk, performed by 922 endoscopists; mean 4 procedures per endoscopist. At its low point, by the end of March, <1800 procedures/wk were being conducted: 5% of pre-COVID activity. In the end of the period 2 week of May, start recovering on average 6974 but still only 20% of pre-COVID activity. |
CRC detected per week Pre- COVID 394 (1.97 per 100 procedures) COVID impacted 112 (5.77 per 100 procedures) Missing CRC in COVID impacted period 2828 (71.7%) Esophageal cancers detected per week Pre-COVID 205 (1.37 per 100 procedures) COVID impacted 129 (6.16 per 100 procedures) Missing esophageal cancers in COVID-impacted period 759 (37.1%) Gastric cancers detected per week Pre-COVID 61 (0.41 per 100 procedures) COVID impacted 29 (1.40 per 100 procedures) Missing gastric cancers in COVID impacted period 320 (52.3%) |
| Maringe, 202052 Modeling study March 16, 2020 modeled to March 15, 2021 Compared with 1-y period January 1, 2010–December 31, 2010, with follow-up data until December 31, 2014 n = 24,975 colorectal cancer n = 6744 esophageal cancer |
United Kingdom Modeling study that estimate the impact of delays in diagnostic pathways due to pandemic lockdown on cancer survival Preprocedure testing: NR |
NR | Estimate a for CRC, 1445 additional deaths (15.3%–16.6% increase); estimate for esophageal cancer, 330 additional deaths, (5.8%–6.0% increase) up to 5 y after diagnosis. |
| Cheng, 202140 Single-center observational cohort study December 2019–April 20 20; n = 6392 |
Taiwan Comparing trends in compliance to diagnostic colonoscopy in FIT-positive patients with corresponding periods in the last 3 years Preprocedure testing: NR |
Screening uptake during COVID-19 was 88.8% compared with 91.2%–92.7% in the prior 3 y Colonoscopy rate during COVID-19 was 66.1% compared with 70.2%–77.5% in the prior 3 y Rescheduling/cancellation was increased to 10.9% during COVID-19 50% of FIT-positive patients declined diagnostic colonoscopy or rescheduled due to fears of being infected from COVID-19 |
NR |
| Tinmouth, 202149 Retrospective population-based modeling study March 2020–August 2020 |
Canadian Comparing colonoscopy procedures performed pre COVID and in COVID period and estimated hospital-based outpatient colonoscopy volume and time to recovery Preprocedure testing: NR |
Predicted backlog colonoscopies for screening estimated to take 41 mo to complete all the backlog of colonoscopies Changing low-yield colonoscopies to FIT would reduce recovery time: 25% reduction to FIT reduces backlog to 28 mo 50% reduction to FIT reduces backlog to 22 mo 75% reduction to FIT reduces backlog to 19 mo |
NR |
| Mizuno, 202046 Single-center retrospective cohort study (1) Period 1: December 18, 2018–April 16, 2019 (2) Period 2: April 17, 2019–August 14, 2019 (3) Period 3: December 19, 2019–April 16, 2020 (4) Period 4:April 17, 2020–August 14, 2020 |
Japan Analyses of 123 of CRC patients who underwent CRC surgery in 4 different periods Preprocedure testing: NR |
Colonoscopies decreased starting in March 2020 until May 21, 2020 with assumption that this led to fewer diagnoses of CRC | No significant change in no. of CRC patients who underwent surgery During COVID-19 period more patients needed emergency admission and more had obstructive CRC (39% vs 15%) Partial/complete obstructions were also increased (67% vs 19%–42%). Increased patients with advanced CRC in period 4 |
| Leeds, 202143 Retrospective cohort study (1) Period 1: pre-lockdown: March 9, 2020–March 22, 2020 (2) Period 2: national lockdown: March 2, 2020–April 19, 2020 (3) Period 3: early recovery phase: April 20, 2020–May 29, 2020 |
United Kingdom Chart review via endoscopy reporting system Comparing no. of procedures, and key performance indicators for 3 time periods with 2019 Preprocedure testing performed |
Period 2 (“lockdown”): 13.3% of expected activity (187 procedures compared with 1402 expected) Period 3 recovery: 28.9% of the expected activity (644 procedures compared with 2154) During period 3: only 84.2% of colonoscopy slots were filled. 25.8% not filled due to patient cancellation or reluctance to attend |
NR |
| Gawron, 202050 Retrospective population-based study (1) March 2020 and April 2020 (2) September 2020 |
United States VA National Database Comparing number of procedures, in COVID impacted period and recovery period Describes the outcomes from the pre-endoscopy PCR testing and reports around 25% procedure cancelation rate, but cannot distinguish how many were from testing strategy |
Decrease in EGD volume compared with a historical average: March 2020 33% April 2020 78% Decrease in colonoscopy volume compared with a historical average: March 2020 42% April 2020 93% Recovery phase September 2020: Overall recover to 70% from the historical average EGD recover to 86% Colonoscopy recover to 61% |
NR |
| Huang, 202021 Single-center retrospective cohort February 1, 2020–May 31, 2020 |
China Comparing no. of procedures, and endoscopic diagnosis in the COVID period with same period in 2019 Preprocedure testing: NR |
Study period: a total of 1808 endoscopic operations compared with 5903 in the same period in 2019; 30.63% of the expected activity | NR |
| Khan, 202141 Retrospective population-based study (1) Early pandemic: March 15, 2020 and July 15, 2020 (2) Later in the pandemic: July 2020 to November 2020 |
United States TriNetX database Comparing no. of procedures, and diagnosis of new GI cancer in the early COVID-19 pandemic period with same period in 2019 Preprocedure testing: NR |
(1) Early pandemic: Estimated decline in patients who underwent endoscopy (71.84%), colonoscopy (84.66%). (2) Later in the pandemic: Estimated decline in patients who underwent endoscopy (64.74%), colonoscopy (61.64%). |
(1) Early pandemic: Decline in new diagnoses of malignant colorectal (30.91%), esophageal and gastric (26.96%) cancers per 100,000 patients (2) Later in the pandemic: Decline in new diagnoses of malignant colorectal (11.74%), esophageal and gastric (19.78%) |
EGD, esophagogastroduodenoscopy; ERCP, endoscopic retrograde cholangiopancreatography; FIT, fecal immunochemical test; GI, gastrointestinal; IQR, interquartile range; NHS, National Health Service; NR, not reported.