Colorectal cancer survivorship program at a single tertiary centre :– Has service provision changed after Covid-19?

Purpose Surveillance after colorectal cancer (CRC) resection is an important aspect of survivorship care. This study aimed to assess whether there were any changes to post-operative surveillance in non-metastatic CRC patients, pre and post-COVID pandemic in Victoria. Methods All CRC patients (stage I-III) who underwent curative surgery at Western Health, Victoria, Australia were included. Surveillance included a three-monthly clinical review and carcinoembryonic antigen (CEA) up to 18 months, and CT imaging and colonoscopy at 12 months following surgical resection. Results Between 2019-2022, 380 patients were identified. Stage III patients had the highest uptake with regards to clinical reviews, CEA testing and 12-month CT (83.3%, 60.3% and 85.5% respectively) while Stage I patients had the lowest (52.7%, 35.7% and 75.5% respectively) (p<0.05). Colonoscopy surveillance was low regardless of stage (66.3%, 59.8% and 59.7% of Stage I, II and III respectively). Uptake of CEA, clinic reviews and colonoscopy did not vary during our study period. More patients underwent 12-month CT following the COVID pandemic (87.0%) compared to pre-COVID (73.1%) or during COVID (76.0%, p<0.05). There was no difference in 18-month mortality and overall recurrence during our study timelines. Conclusion Patients with earlier stage CRC had lower rates of adherence to surveillance protocols, particularly with regard to CEA monitoring and colonoscopic surveillance. Adherence to surveillance and surveillance patterns were not meaningfully altered by the intra or post COVID-19 era.