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Gastrointestinal Cancer Stage at Diagnosis Before and During the COVID-19 Pandemic in Japan

Educational Objective
To identify the key insights or developments described in this article
Key Points

Question  Is the COVID-19 pandemic associated with the stage at which gastrointestinal cancer is diagnosed in Japan?

Findings  In this cohort study of 5167 patients, significant decreases were observed for the diagnosis of stage I gastric cancer and stage 0 to II colorectal cancer, whereas a significant increase was observed for the diagnosis of stage III colorectal cancer.

Meaning  These findings suggest that during the COVID-19 pandemic, there may have been fewer cases of screening-detected gastrointestinal cancer, and colorectal cancer may have been diagnosed at more advanced stages.

Abstract

Importance  The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages.

Objective  To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic.

Design, Setting, and Participants  This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals.

Exposures  The pre–COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020.

Main Outcome and Measure  Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared.

Results  The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre–COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre–COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; –26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; –13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; –35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; –32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; –34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; –35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001).

Conclusions and Relevance  In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.

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Article Information

Accepted for Publication: July 26, 2021.

Published: September 21, 2021. doi:10.1001/jamanetworkopen.2021.26334

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Kuzuu K et al. JAMA Network Open.

Corresponding Author: Takuma Higurashi, MD, PhD, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan (takuma_h@yokohama-cu.ac.jp).

Author Contributions: Drs Higurashi and Nakajima had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed the final version of the manuscript and agreed to its submission.

Concept and design: Kuzuu, Misawa, Ashikari, Hosono, Matsushima, Komatsu, Nakajima, Higurashi.

Acquisition, analysis, or interpretation of data: Kuzuu, Misawa, Kessoku, Kato, Yoneda, Nonaka.

Drafting of the manuscript: Kuzuu, Misawa, Ashikari, Hosono, Komatsu.

Critical revision of the manuscript for important intellectual content: Kuzuu, Misawa, Kessoku, Kato, Yoneda, Nonaka, Matsushima, Nakajima, Higurashi.

Statistical analysis: Kuzuu, Misawa.

Obtained funding: Nonaka.

Administrative, technical, or material support: Misawa, Kessoku, Kato, Komatsu, Nakajima, Higurashi.

Supervision: Ashikari, Kessoku, Hosono, Yoneda, Matsushima, Nakajima, Higurashi.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the staff at each participating institution for their support with data collection.

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