An Analysis of the Impact of COVID-19 Pandemic-related Lockdown Measures on a Large Gastrointestinal Pathology Service in the United States

Aejaz Nasir; Brooke Hough; Caterina Baffa; Arun Khazanchi; Domenico Coppola

doi:10.21873/cdp.10125

An Analysis of the Impact of COVID-19 Pandemic-related Lockdown Measures on a Large Gastrointestinal Pathology Service in the United States

Cancer Diagn Progn. 2022 Jul 3;2(4):422-428. doi: 10.21873/cdp.10125. eCollection 2022 Jul-Aug.

Authors

Aejaz Nasir¹, Brooke Hough¹, Caterina Baffa¹, Arun Khazanchi¹, Domenico Coppola¹

Affiliation

¹ Department of Pathology, Florida Digestive Health Specialists, Florida Research Institute, Bradenton, FL, U.S.A.

Abstract

Background/aim: The coronavirus disease 2019 (COVID-19) pandemic prompted global recommendations to delay non-urgent endoscopic procedures to limit the spread of SARS-COV-2, but such delays had unprecedented impact on the delivery of healthcare. Being a large specialty GI Pathology service, we sought to analyze the effect of the pandemic on the frequency of GI malignancies in our department.

Patients and methods: Based on the electronic search of departmental pathology records, we compared the total numbers of cancer diagnoses (primary and metastatic) from various GI biopsy sites during the 12-month pre- and post-pandemic periods. We summarized patient demographics and analyzed pertinent histopathologic data.

Results: For all GI biopsy sites, the number of intramucosal/invasive malignancies reported during the one-year pre-COVID-19 pandemic (pre-COVID) and post-COVID-19 pandemic national lockdown (post-COVID) observation periods were 146 and 218, respectively. Among these, 32 and 70 malignancies were reported for the first quarter (representing the earliest post-lockdown period), 29 and 53 for the second, 41 and 54 for the third, and 44 and 41 for the fourth quarter. During the first two quarters of the post-COVID observation period, the increase in malignant diagnoses was most profound, showing 119% post-COVID increase compared to the pre-COVID levels. Of the two main primary histologic types of large intestinal carcinomas [adenocarcinoma (ADC) and squamous cell carcinoma (SCC)], the most profound post-COVID increase was noted in SCCs (136% vs. 58% for ADCs).

Conclusion: Compared to the pre-pandemic baseline, the COVID-19 pandemic caused a major increase in biopsy diagnoses of GI cancers in our department. The most plausible explanations for this trend include inevitable lockdowns to minimize the spread of SAR-COV2, which affected GI endoscopy procedure schedules/re-schedules as well as patient response and adaptation to emerging post-COVID GI healthcare patterns. The COVID-19 pandemic's long-term impact on the health of GI cancer patients will need to be determined through systematic analyses by multi-disciplinary teams.

Keywords: COVID-19 pandemic; GI endoscopy; Gastrointestinal cancer; diagnosis; gastroenterology; impact.