COVID-related disruptions to colorectal cancer screening, diagnosis, and treatment could increase cancer Burden in Australia and Canada: A modelling study

Joachim Worthington; Zhuolu Sun; Rui Fu; Jie-Bin Lew; Kelvin K W Chan; Qing Li; Antoine Eskander; Harriet Hui; Kirstie McLoughlin; Michael Caruana; Stuart Peacock; Jean Hai Ein Yong; Karen Canfell; Eleonora Feletto; Talía Malagón

doi:10.1371/journal.pone.0296945

COVID-related disruptions to colorectal cancer screening, diagnosis, and treatment could increase cancer Burden in Australia and Canada: A modelling study

PLoS One. 2024 Apr 1;19(4):e0296945. doi: 10.1371/journal.pone.0296945. eCollection 2024.

Authors

Joachim Worthington¹, Zhuolu Sun², Rui Fu^{3

4

5}, Jie-Bin Lew¹, Kelvin K W Chan^{4

6

7}, Qing Li³, Antoine Eskander^{3

4

5}, Harriet Hui¹, Kirstie McLoughlin¹, Michael Caruana¹, Stuart Peacock^{8

9}, Jean Hai Ein Yong², Karen Canfell¹, Eleonora Feletto¹, Talía Malagón^{10

11}

Affiliations

¹ The Daffodil Centre, Kings Cross, New South Wales, Australia.
² Canadian Partnership Against Cancer, Toronto, ON, Canada.
³ ICES, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁷ Canadian Centre for Applied Research in Cancer Control, Canada.
⁸ Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
⁹ BC Cancer Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia, Canada.
¹⁰ Department of Oncology, McGill University, Montréal, Canada.
¹¹ St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Canada.

Abstract

COVID-19 disrupted cancer control worldwide, impacting preventative screening, diagnoses, and treatment services. This modelling study estimates the impact of disruptions on colorectal cancer cases and deaths in Canada and Australia, informed by data on screening, diagnosis, and treatment procedures. Modelling was used to estimate short- and long-term effects on colorectal cancer incidence and mortality, including ongoing impact of patient backlogs. A hypothetical mitigation strategy was simulated, with diagnostic and treatment capacities increased by 5% from 2022 to address backlogs. Colorectal cancer screening dropped by 40% in Canada and 6.3% in Australia in 2020. Significant decreases to diagnostic and treatment procedures were also observed in Australia and Canada, which were estimated to lead to additional patient wait times. These changes would lead to an estimated increase of 255 colorectal cancer cases and 1,820 colorectal cancer deaths in Canada and 234 cases and 1,186 deaths in Australia over 2020-2030; a 1.9% and 2.4% increase in mortality, respectively, vs a scenario with no screening disruption or diagnostic/treatment delays. Diagnostic and treatment capacity mitigation would avert 789 and 350 deaths in Canada and Australia, respectively. COVID-related disruptions had a significant impact on colorectal cancer screening, diagnostic, and treatment procedures in Canada and Australia. Modelling demonstrates that downstream effects on disease burden could be substantial. However, backlogs can be managed and deaths averted with even small increases to diagnostic and treatment capacity. Careful management of resources can improve patient outcomes after any temporary disruption, and these results can inform targeted approaches early detection of cancers.

Copyright: © 2024 Worthington et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Australia / epidemiology
COVID-19 Testing
COVID-19* / diagnosis
COVID-19* / epidemiology
Canada / epidemiology
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / therapy
Early Detection of Cancer
Humans

Grants and funding

This work was supported by the Ontario Health Data Platform (OHDP), a Province of Ontario initiative to support Ontario’s ongoing response to COVID-19 and its related impacts. This study was supported by the Canadian Institutes of Health Research [operating grants VR5-172666, 179892] and a Sunnybrook Research Institute and Sunnybrook Foundation COVID-19 Response Grant. The funders had no role in the design and conduct of the study, nor the decision to prepare and submit the manuscript for publication. OncoSim is led and supported by the Canadian Partnership Against Cancer, with model development by Statistics Canada, and is made possible through funding from Health Canada. The funder provided support in the form of salaries for authors ZS and JHEY, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. There was no additional external funding received for this study.