{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T15:42:50Z","timestamp":1794411770977,"version":"4.9.0"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: During the COVID-19 pandemic, many countries implemented lockdowns and social distancing measures, which may delay the early diagnosis of colorectal cancer (CRC). This study aims to review the impact of the pandemic on the diagnosis and treatment outcomes of CRC. Materials and Methods: Patients who underwent colonoscopy or surgery for CRC were included. The study was divided into the pre-COVID-19 (January 2019\u2013January 2020), early COVID-19 (February\u2013May 2020), recovery (June\u2013December 2020), and heightened alert (January\u2013December 2021) periods. Cox regression was used to model the waiting time to colonoscopy. Multivariable logistic regression identified associations between time periods and incidence of CRC diagnosed. The characteristics and outcomes of the surgical procedures that were performed were compared across the time periods. Results: A total of 18,662 colonoscopies and 1462 surgical procedures were performed in the study period. Compared to the pre-COVID-19 period, there was a longer time to colonoscopy during the recovery (HR: 0.91; 95% CI: 0.87, 0.94) and heightened alert periods (HR: 0.88; 95% CI 0.85, 0.91). The early COVID-19 (OR: 1.36; 95% CI: 1.04, 1.77) and recovery (OR: 1.20; 95% CI: 1.01, 1.43) periods were associated with higher odds of diagnosing CRC. Compared to the pre-COVID-19 period, there was a higher proportion of ASA 4 patients (4.3% vs. 1.3%; p &lt; 0.001) and stage 4 CRC patients (22.2% vs. 16.9%; p = 0.001) that required surgery during the heightened alert period. Similarly, there was a higher proportion of emergency surgeries (22% vs. 13.3%; p = 0.002); diverting stomas (13.5% vs. 10.5%; p = 0.005), and Hartmann\u2019s procedures (4.4% vs. 0.4%; p = 0.001) performed during the heightened alert period. Conclusions: The pandemic was associated with a higher proportion of metastatic CRC patients requiring surgery. Healthcare policies should facilitate early cancer screening, diagnosis, and treatment to reduce cancer-related morbidity for future pandemics.<\/jats:p>","DOI":"10.3390\/medicina61010138","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:55:19Z","timestamp":1737003319000},"page":"138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Impact of COVID-19 Pandemic on the Diagnosis, Treatment, and Outcomes of Colorectal Cancer in Singapore"],"prefix":"10.3390","volume":"61","author":[{"given":"Hui Lionel Raphael","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore"},{"name":"Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5517-353X","authenticated-orcid":false,"given":"Piea Peng","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore"},{"name":"Group Finance Analytics, Singapore Health Services, Singapore 168753, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Hao Caleb","family":"Ng","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiashen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4245-5488","authenticated-orcid":false,"given":"Yu En Christopher","family":"Tan","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo Jie Sean","family":"Loh","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0584-2584","authenticated-orcid":false,"given":"Kah-Hoe Pierce","family":"Chow","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, Singapore 169857, Singapore"},{"name":"Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore"},{"name":"SingHealth Duke-NUS Global Health Institute, Singapore 168582, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8565-2926","authenticated-orcid":false,"given":"Hiang Khoon","family":"Tan","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, Singapore 169857, Singapore"},{"name":"Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore"},{"name":"SingHealth Duke-NUS Global Health Institute, Singapore 168582, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwong-Wei Emile","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore"},{"name":"Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","unstructured":"White Paper on Singapore\u2019s Response to COVID-19 (2023, October 20). 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