Timely treatment for patients with colorectal cancer may have been disrupted by the COVID-19 pandemic. We evaluated the impact of the pandemic on delays to treatment with surgery or systemic therapy for patients with colorectal cancer and delineated factors predictive of delayed treatment.
Using the National Cancer Database, patients diagnosed with colorectal cancer were categorized by year of diagnosis as COVID era (2020) versus pre-COVID (2018-2019). Categorical variables were compared by χ analysis. Multivariate logistic regression was used to assess odds ratios for delayed time to surgery or chemoimmunotherapy, defined as >60 days.
In total, 50,689 patients colorectal cancer were diagnosed patients who were pre-COVID vs 21,331 within the COVID-era. Patients diagnosed with COVID had a higher stage at diagnosis. There were no differences in the proportion of delayed time to surgery for patients diagnosed in 2020, but patients who were tested for COVID had increased proportions of delayed time to surgery (P < .0001). In multivariate analysis, Black race (P = .0026) and uninsured/underinsured status (P = .0017) were associated with delayed time to surgery. Diagnosis during COVID did not increase delayed time to chemoimmunotherapy, regardless of COVID testing or positivity; however, delays were seen for Black (P < .0001), Hispanic (P < .0001), and uninsured/underinsured patients (P < .0001).
Although the pandemic did not delay treatment for colorectal cancer overall, vulnerable and underserved populations were disproportionately affected by delays to all forms of therapy. The difference in colorectal cancer outcomes in the coming years as a result of delays in treatment may be significant for these patients.

Copyright © 2023 Elsevier Inc. All rights reserved.