Impact of the COVID-19 pandemic on mortality and treatment costs of patients with colorectal cancer

Background

The COVID-19 pandemic negatively impacted lung cancer patient’s mortality and health services utilization (HSU) costs; however, it is unclear if these impacts are true for other cancers, such as colorectal cancer (CRC).

Methods

A population-based retrospective cohort design was used to compare 1-year mortality, survival, HSU and associated costs of patients who were diagnosed with CRC in Alberta, Canada during pre-pandemic (March 17th, 2018 to March 16th, 2019), intra-pandemic (March 17th, 2020 to March 16th, 2021), and post-pandemic (March 17th, 2021 to March 16th, 2022) periods. Kaplan-Meier and Cox regressions were used to estimate survival and hazard ratios. General linear regression models with gamma family and log link were used to estimate differences in HSU costs.

Results

There were 2297, 2003 and 2393 patients diagnosed with CRC (incidence of 53, 45, and 54 per 100,000 population) in the pre-, intra-, and post-pandemic periods, respectively. Across the three periods, the proportion of stage III & IV CRC at diagnosis was 39.4 %, 42.4 % and 40.1 %; and survival at 365 days was 81.3 %, 79.2 %, and 81.0 %, respectively. Although the highest 1-year mortality was found intra-pandemic, differences were not statistically significant. The highest HSU costs were found among patients diagnosed with CRC during the intra-pandemic period ($61,800 per patient per year), followed by pre- ($57,140) and post-pandemic ($50,680).

Conclusion

For patients diagnosed with CRC, there are associations between the COVID-19 pandemic, delay in cancer diagnosis (as shown by the decreased incidence and the increased proportion of later stage cancer at diagnosis), and increased mortality and treatment costs. As these findings are similar to what has been found for lung cancer patients, generalizability to other cancers becomes more likely.