Impact of the COVID-19 pandemic on adherence to diagnostic colonoscopy after a positive non-invasive screening test for colorectal cancer in two Indiana healthcare systems

Abstract

Objective: To describe trends in the use of non-invasive tests (NIST) and the interval between a positive NIST and diagnostic colonoscopy. Methods: Using a retrospective time-trend design, we examined medical records of patients within two large Indiana integrated healthcare systems who had a positive NIST between January 2019 and June 2021 and quantified the proportion of patients who had not completed colonoscopy within 60, 90, and 180 days to determine the interval between NIST result and diagnostic colonoscopy in days. Results: Of 1379 patients with positive NISTs, 930 (68 %) underwent diagnostic colonoscopy during the 30-month study timeframe. Median time to colonoscopy completion was significantly longer in 2020 compared to 2019 (50 vs. 37 days, p < 0.01) and 2021 (46 days, p = 0.06). The proportion of patients completing colonoscopy within 90 days of a positive FIT in 2019, 2020, and 2021 were 79 %, 83 %, and 72 %, respectively (p = 0.63), and were 86 %, 78 %, and 84 %, respectively, after positive FIT/DNA (p = 0.07). Median time to diagnostic colonoscopy completion was significantly longer in 2020, likely due to the COVID-19 pandemic. Conclusions: Studies of outcomes in those who declined or delayed colonoscopy in 2020 are needed to estimate the potential subsequent colorectal cancer disease burden.