Table 1.
The characteristics of articles included in a systematic review of screening delay of colorectal cancer in the COVID-19 pandemic
| First author (year) | Place (country) | Sample size | Type of study | Age | Sex | Comparison date | Examined indicators | Result of quality assessment |
|---|---|---|---|---|---|---|---|---|
| Wassie et al. (2021) [12] | South Australia | 1760: 1164 pre-COVID-19 and 596 after COVID-19 | Retrospective analysis | All ages | Both | April–June 2020 vs the same time in 2019 |
- Total number of colonoscopies: 51.1% decrease (596 vs. 1164) - Completed colonoscopies for surveillance: 65.6% decrease (32.0% (n = 182) vs. 45.5% (n = 530)) - 3-month delay for surveillance colonoscopies: 68.0% (198/291) vs. 52.9% (162/306); P < 0.001 - > 6-month delay for surveillance colonoscopies: 46.1% (134/291) vs. 19.3% (59/306); P < 0.001 - Nonresponses percent to surveillance recall letters in patients ≥ 75 years: 51.6% vs. 25.6%, P = 0.03 - Proportion of urgent colonoscopies: increase from 71.2% (828/1163) to 78.2% (445/569) - Number of nonurgent colonoscopies: 63.0% reduction, P = 0.002 (from 335 to 124) - Median time taken to respond to the recall colonoscopy letter: 18 days, IQR 11–41 days vs. 21 days, IQR 12–48 days; P = 0.23 Decrease by colonoscopy procedures: Surveillance: 182(32.0%) vs. 530(45.5%); p < 0.001 - Positive FIT: 140 (24.6%) vs. 233 (20.0%); p = 0.03 - Symptomatic: 204 (35.9%) vs. 349 (30.0%); p = 0.01 - Abnormal abdominal radiology: 32 (2.8%) vs. 32 (5.6%); p = 0.003 |
Good |
| Tinmouth et al. (2021) [13] | Canada | 143,063: 107,034 before COVID-19 and 36,029 after it | Retrospective cohort | All ages | Both | March–June 2020 vs. the same time in 2019 |
- gFOBT+/FIT+: 8% increase (4758 vs. 4390) - Symptomatic colonoscopy: 56% decrease (19501 vs. 44651) - Surveillance colonoscopy: 79% decrease (6033 vs. 28,107) - Average-risk screening: 81% decrease (3603 vs. 19,031) - All colonoscopies: 66% decrease (36,029 vs. 107,034) |
Good |
| Shinkwin et al. (2021) [14] | UK | 811: 272 in 2020; 539 in 2019 and 2018 | Retrospective cohort | All ages | Both | March and June 2020 compared with previous years | - Emergency presentation: 36.0% vs. 28.6%; p = 0.03 | Good |
| Rutter et al. (2021) [15] | UK | 39,790: 4312 COVID impacted and 35,478 pre-COVID | Retrospective cohort | All ages | Both | 23 March 2020–31 May 2020 vs. 6 January 2020–15 March 2020 |
- Average number of all procedures per week: 87.8% reduction (4312 vs. 35,478) - Average number of colonoscopy per week: 89.7% reduction (1300 vs. 12,646) - Average number of flexible sigmoidoscopies per week: 91.4% reduction (632 vs. 7335) - Average number of OGD per week: 86.0% reduction (2091 vs. 14,985) - Average number of ERCP per week: 43.7% reduction (289 vs. 513) |
Moderate |
| Myint et al. (2021) [16] | USA | Cross sectional | All ages | Both | Endoscopy cessation period (3/18/2020–5/4/2020) vs. before the cessation (1/29/2020–3/17/2020 |
- Number of total screening tests per week: 74.3 ± 47.1 vs. 382.4 ± 54.8; p < 0.01 - Number of colonoscopies per week: 11.4 ± 11.1 vs. 223.8 ± 33.3 ; p < 0.01 - Number of FIT test per week: 60.6 ± 52.7 vs. 154.0 ± 25.2; p < 0.02 |
Good | |
| Morris et al. (2021) [36] | England | All ages | Both | in April, 2020 compared to the monthly average in 2019 |
- Monthly number of 2-week referrals for suspected cancer: 63% (95% CI 53–71) reduction (from 36,274 to 13,440) - Number of colonoscopies: 92% (95% CI 89–95) reduction (from 46,441 to 3484) |
Good | ||
| Miller et al. (2021) [29] | UK | 422: 202 males and 220 females | Median age 64 years | Both | 1 April to 31 May 2020 vs. same times in 2017–2019 |
- Primary care referrals: 43% reduction (1071 referrals expected reducing to 609) - Median time to first test: 14 days (IQR 10–18 days) - Routine referrals: 64% reduction (from 581 to 211) - Urgent referrals: 79% reduction (from 1071 to 609) - USOC referrals: 40% increase (from 235 to 329) |
Good | |
| Meyer et al. (2021) [32] | France | - | - | - | Both | February 17 to September 13, 2020, vs. same time in 2108 and 2019 | - Colonoscopy preparations: 68.6% fewer than expected; 83,045 vs 181,826 | Good |
| Longcroft-Wheaton et al. (2021) [17] | UK | - | Service evaluation | All ages | Both | Over 8-week periods in spring, summer, and autumn 2019 vs. the first 6 weeks COVID-19 crisis |
- Number of colonoscopies per week: decrease from 86 to 12 - Number of Flexible sigmoidoscopies per week: decrease from 108 to 10 - Endoscopic procedures/week required to diagnose a CRC cancer: decrease from 47 to 12 |
Good |
| Lantinga et al. (2021) [18] | Netherlands | - | Retrospective analysis | - | Both | March 15 to June 25 in 2020 vs same time in 2019 |
- Number of colonoscopies: 45% decrease (from 12,219 to 5609) - Surveillance colonoscopy: declined from 35.0% (95%CI 33.9–36.1) in 2019 to 19.4% (95%CI 18.1–20.8) in 2020; P < 0.001 - Hematochezia indications for colonoscopy: declined from 38.4% (95%CI 36.7–40.1) in 2019 to 26.7% (95%CI 25.7–27.8) in 2020; P < 0.001 |
Good |
| Lahat et al. (2021) [19] | Israel | - | - | All ages | Both | January–March in 2020 vs. same time in 2019 and 2018 | - Colonoscopy and sigmoidoscopy: 52–57% reduction in 2020 (464 vs. 955 and 1058 on 2018 and 2019; p < 0.0001 | Good |
| Koczkodaj et al. (2021) [31] | Poland | - | - | All ages | Both | between January and April 2020 vs. same period in 2019 |
- Colonoscopy coverage and participation rate (last available month data): 7.09% in 2020 vs. 13.16% in 2019 - Number of oncology diagnosis and treatment cards (ODaTCs): 135 less cards (from 3583 in July 2019 to 3448 in July 2020) - Colonoscopy participation rate in April and May 2020 vs. same time in 2019: 4.93%. vs. 17% - Number of patients with referrals to the fast path of oncological diagnosis and treatment: 51% (2161) decrease |
Good |
| Kirac et al. (2021) [20] | Croatia | - | Cross sectional | All ages | Both | From August 1, 2019, until August 31, 2020 | - Number of colonoscopies in August 2019 vs. April 2020: 82% decrease (50 vs. 9) | Good |
| Gurney et al. (2021) [21] | New Zealand | - | - | All ages | Both | 2020 vs. 2019 | - Gastrointestinal endoscopies: 75% sharp decline during late March and April 2020 (from 5734 to 1426) | Good |
| Gorin et al. (2021) [22] | USA | - | - | All ages | Both | Between March 19 and May 9 in 2017 and 2020 | - Colonoscopy screening: decreased from 1291 to 8 | Good |
| Boyle et al. (2021) [33] | England and Wales | - | National survey | All ages | Both | In mid-April 2020 |
Reduction in diagnostic colonoscopy activity by: - 0–10% of usual capacity: 95 (77%) hospitals; - 11–70% of usual capacity: 26 (21%) hospitals; - 71–100% of usual capacity: 2 (2%) hospitals |
Moderate |
| D’Ovidio et al. (2021) [30] | Italy | Case = 60; control = 238 | Retrospective controlled cohort | All ages | Both | 9th March–4th May 2020 vs. same time in 2019 | - Invited patients underwent endoscopy: 74.8% decrease (from 238 to 60) | Good |
| Al-Kuwari et al. (2021) [23] | Qatar | - | Retrospective data analysis | All ages | Both | From the 1st of January 2017 to the 31st of July 2020 |
- Number of missed appointments colorectal cancer screening: 5854 - Dropped in the colorectal cancer screening service utilization by 100% from April to July 2020 |
Good |
| Cheng et al. (2020) [24] | Taiwan | - | Prospective observational | Ages 50 to 75 | Both | January 21, 2020, to April 2020 vs. same time in 2019, 2018, 2016, 2017 |
- FIT screening uptake: Q4 2019 to Q1 2020, 88.1% vs. 92.1% Q4 2018 to Q1 2019; 91.2% Q4 2017 to Q1 2018; and 92.7% Q4 2016 to Q1 2017 (P for trend < 0.0001) - Colonoscopy rate: 66.1% in Q1 of 2020 (70.2%, 77.5%, and 75.4% in 2017, 2018, and 2019, P for trend = 0.017) - Diagnostic colonoscopy rescheduling/cancelation rate: 10.9% in Q1 2020 (P for trend = 0.023) |
Good |
| London et al. (2020) [25] | UK | - | - | - All ages | Both | January 1, 2019, through April 30, 2020 | - Percent change in cancer screenings (2019–2020): 84.5% decrease | Good |
| Mizuno et al. (2020) [26] | Japan | - | Retrospective cohort | All ages | Both | December 19, 2019. to August 14, 2020 vs. December 18, 2018, to August 14, 2019 |
- Screening or diagnostic colonoscopies: 14.1% decrease (from 1379 to 1184) - Emergency admission: increase from 18.2 to 38.7% |
Good |
| Maida et al. (2020) [34] | Italy | - | National survey | All ages | Both | After the COVID-19 pandemic |
GI divisions activity compared to before the pandemic: - Without change: 3/121 (2.5%) - Undergone a clinical rearrangement: 118/121 (86.8%) - Converted to COVID Units: 13/121 (10.7%) - Sharp slowdown in admissions and consultations: 103/121 (85.1%) - Completely suspended: 18/121 (14.9%) - Activating the remote consultancy and follow-up service: 83/121 (68.6%); (63.9% by phone, 31.3% by email, 4.8% by video) |
Good |
| Maclean et al. (2020) [35] | UK | 381 | Observational cohort | All ages | Both | 26 March to 2 July 2020 vs. 1 October to 31 December 2019 |
- Time waiting for consultation: increase from 0 day to 2 weeks - Referral for colonoscopy: reduced from 62 to 34%; P < 0.001 - Telephone consultations: decrease from 590 to 381 with below outcomes: - Colonoscopy ± OGD ± CT abdomen/pelvis screening: decrease from 365 (62%) to 129 (34%); p < 0.001 - CT abdomen/pelvis screening: increase from 40 (6.8%) to 46 (12%); p = 0.005 - Discharged from screening: decrease from 31 (5.3%) to 82 (22%); p < 0.001 |
Good |
| Lui et al. (2020) [27] | China | - | - | All ages | Both | Jan 21–27 2020 vs. Jan 21–27 2019 | - Average number of lower endoscopies per week: 58.8% decrease (from 1190 to 491); p < 0.001 | Good |
| Carethers et al. (2020) [28] | USA | - | Commentary | All ages | Both | April 2020 vs. 2019 | - Colorectal cancer screening: 84.5% decrease | Moderate |