Impact of the COVID-19 Pandemic on Colorectal Cancer Characteristics and Overall Survival: A Population-Based Analysis of Kuwait Cancer Registry Data

Abstract

Background: The COVID-19 pandemic substantially disrupted cancer care worldwide. In Kuwait, colorectal cancer (CRC) is the second most commonly diagnosed cancer. This study evaluated differences in patient and tumor characteristics, treatment patterns, and four-year survival outcomes among Kuwaiti patients with CRC diagnosed before, during, and after the COVID-19 pandemic.

Methods: A retrospective analysis was conducted using data from the Kuwait Cancer Registry (KCR). A total of 582 Kuwaiti patients with CRC were included and categorized into three cohorts according to year of diagnosis: 2019 (pre-pandemic, n = 199), 2020 (pandemic, n = 181), and 2021 (post-pandemic, n = 202). The KCR database provided demographic, clinical, and tumor-related information. Data were exported from CanReg-5 to Microsoft Access and SPSS for statistical analysis.

Results: The number of newly diagnosed CRC cases decreased by 9% in 2020 compared with 2019 and by 10.4% compared with 2021. Patient status at last follow-up differed significantly across the three periods, with fewer patients recorded as alive during the pandemic period (p = 0.015). Compared with 2021, CRC-related mortality during the pandemic period was 44.1% higher. The proportion of stage IV disease at diagnosis increased by 12.7% in 2020 compared with 2021, whereas the proportion of stage III disease increased by 65.1% in 2021. Treatment patterns also changed during the pandemic, with fewer patients undergoing surgery or receiving chemotherapy and a relative increase in radiotherapy. However, no statistically significant difference in survival was observed among the three cohorts (p = 0.107).

Conclusion: The COVID-19 pandemic was associated with changes in CRC diagnosis, disease stage at presentation, treatment patterns, and mortality in Kuwait. The reduction in newly diagnosed cases, increased proportion of stage IV disease, and higher CRC-related mortality during the pandemic suggest potential delays in diagnosis and treatment. Continued monitoring of CRC outcomes and strategies to minimize the impact of future healthcare disruptions are warranted.