Effect of the COVID-19 pandemic on colorectal cancer care in France

We welcome the Article by Eva Morris and colleagues¹ on the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. In France, a first strict nationwide lockdown was implemented on March 17, 2020, and lifted on May 11, 2020. A second nationwide lockdown was then enforced between Oct 30, 2020, and Dec 15, 2020.

We used the Electronic Health Record Database of Assistance Publique–Hôpitaux de Paris (AP–HP), the main health-care provider in the Paris region, to examine the effect of the first national lockdown in France on colorectal cancer care. The database contains 11 million patient records; AP–HP manages around 10% of cancer cases in France.

We used claims data from Jan 1, 2018, to Oct 31, 2020, to identify patients newly referred to an AP–HP hospital for a colorectal cancer (appendix). We observed similar trends to those published by Morris and colleagues: from March 1 to May 31, 2020, there were 339 newly referred patients for colon cancer. By contrast, there were 505 new referrals over the same period in 2018 and 478 over the same period in 2019, representing a 31% decrease in new referrals in 2020 relative to the average of the previous 2 years. Similarly, there were 119 new referrals for rectal cancer between March 1 and May 31, 2020, compared with 155 in the same period in 2018 and 166 in the same period in 2019, representing a 26% decrease relative to the 2018–19 average. New referrals for colorectal cancer remained lower than that during previous years between June 1 and Oct 31, 2020, a decrease of 8% for colon cancers and 13% for rectal cancers, relative to the average in the same period of the previous 2 years (appendix).

The number of surgeries for colorectal cancer also fell between March 1 and May 31, 2020. 212 surgeries were done for newly referred colorectal cancers, compared with 323 in the same period of 2018 and 320 in the same period of 2019, representing a 34% decrease in 2020 relative to the 2018–19 average. Between June 1 and Oct 31, 2020, there were 439 surgeries for colorectal cancer, compared with 567 in the same period of 2018 and 494 in the same period of 2019, representing a 17% decrease relative to the 2018–19 average (appendix).

Other French studies complete the picture. A national-level study based on claims data also found a 17·7% decrease of colorectal resections in France between January to September, 2019, compared with January to September, 2020.² For radiotherapy, evidence of increased use of hypofractionation was reported in France, although not specifically for colorectal cancer.³ Indirect national-level information on screening has been published by the National Medication Safety Agency.⁴ During the spring lockdown of 2020, consumption of colonoscopy products decreased by 46·4% during March 16–29, by 85·6% between March 30 and April 12, by 77·4% during April 13–26, and by 66·1% between April 27 and May 10, compared with what was expected from data from the previous 2 years. A separate study concluded that, between Jan 1 and May 12, 2020, 152 114 fewer colonoscopies were done in France compared with the same period in 2019, a 32% decrease.²

Because of delayed detection and inappropriate patient pathways, we join Morris and colleagues in their concerns about the probable mid-term impact of COVID-19's disruption on colorectal cancer prognosis.

We declare no competing interests. This work was supported by a grant from ARC Foundation for cancer research (grant reference COVID202001343).