International Journal of Environmental Research and Public Health | |
Delayed Colorectal Cancer Diagnosis during the COVID-19 Pandemic in Alberta: A Framework for Analyzing Barriers to Diagnosis and Generating Evidence to Support Health System Changes Aimed at Reducing Time to Diagnosis | |
Heather Chappell1  Paula Robson1  Douglas Stewart2  Patricia Tang3  Daniel C. Sadowski4  Sander Veldhuyzen van Zanten4  Emily Walker5  Yunting Fu5  Bethany Kaposhi5  | |
[1] Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3C6, Canada;Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3H1, Canada;Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada;Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2X8, Canada;Surveillance and Reporting, Advanced Analytics, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada; | |
关键词: colorectal cancer; COVID-19; delayed diagnosis; colonoscopy capacity; health system planning; administrative data analysis; | |
DOI : 10.3390/ijerph18179098 | |
来源: DOAJ |
【 摘 要 】
The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016–4 March 2020) and intra-pandemic (5 March 2020–1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.
【 授权许可】
Unknown