As the COVID-19 pandemic shows no evidence of slowing down, many cancer surgeons worldwide have begun to devise models to aid with the prioritization of canceled (backlog) elective and upcoming cancer surgeries. Researchers have also strongly advised conducting COVID-19 testing at various time points before and after any surgical procedures with the aim of minimizing the risk of COVID-19—related mortality peri- and postoperatively, particularly in high-risk patients undergoing major surgeries. Thus, in most ways, it can be argued that elective surgeries on non-COVID patients are burdened similarly to those with COVID-19, by increasing waiting times and costs.


The SWALIS 2020 Model 

In 2009, the SWALIS prioritization model was developed “to implicit urgency criteria, time-based priority-based scheduling, and waiting list measuring indexes.” During the 2020 European Society of Surgical Oncology (ESSO)’s annual meeting, speaker and scientist, Roberto Valente, MD, Ph.D., who was involved in modifying this model, shared their findings from implementing it in Spring 2020 to prioritize elective surgery throughout and beyond the COVID-19 pandemic in Italy.

The SWALIS 2020 is a ‘software-aided inter-hospital multidisciplinary pathway’ that dynamically reorders the surgical waiting list for cancer patients from least to most urgent in real-time, thereby ensuring priority-based surgical access and scheduling for past, present, and incoming patients. There are three main stages to this dynamic scheduling:

  • Clinical triage assessed using patient clinical history, pre-administrative information, clinical urgency, and demand modulation
  • Prioritization and selection calculated by dividing the maximum by the actual waiting time for that patient
  • Timely allocation of the surgery computed by the expected priority and weekly forecasted capacity demand

SWALIS 2020 uses these three steps to automatically allocate resources on the basis of oncological demand and significantly reduces the timeframe from consult to surgery by autonomously putting together an MDT for the patient, allowing hospitals adopting SWALIS 2020 to rapidly respond to the patients’ needs depending on the level of surgical urgency. Data shows that these three urgency categories were most commonly used to classify tumor progression when using the SWALIS 2020 model during the pandemic: A1 – 15 days (certain rapid disease progression), A2 – 21 days (probably progression), and A3 – 30 days (potential progression).

The results following the SWALIS 2020 feasibility phase (n=55 patients) showed that 240 referrals were successfully prioritized using this model without any major criticalities. Additionally, when researchers monitored the waiting time data for patients and operation theatre allocation for surgeons, they found that 222 cancer patients underwent surgery without related complications or delayed discharges. These results allowed Dr. Valente and his team to objectively quantify the effectiveness of the SWALIS 2020 model—it was 88.7% effective in week 1, then persistently 100% effective during the remainder of the phase. Even at a 30% or lower capacity, this model can consistently and smoothly manage active and backlogged waiting lists, making it one of the first autonomic models for dynamic patient scheduling. Dr. Valente and his team concluded that the SWALIS 2020 model for dynamic patient scheduling was effectively optimizing oncological surgeries based on urgency. The success of this early pilot study paves the way for future collaboration to create an effective dynamic waiting list and surgical scheduling platform during the next phase of the pandemic.



While health care professionals may argue that the change in cancer surgical oncology catalyzed by the ongoing COVID-19 pandemic is disruptive, scientists and researchers strongly believe that this reshaping will vastly improve the future of cancer care and strengthen the health economy. One could make the argument that this restructuring is necessary for improving patient outcomes and facilitating patient care. Consequently, many automated models similar to SWALIS 2020, which create waiting lists and guide elective prioritization, are being developed to fundamentally alter the field of surgical oncology for the better.


As COVID-19 continues to spread like wildfire, it becomes increasingly important to tackle the growing backlog of cancer surgeries. While returning to normal is currently not an option, a lot of hospitals around the world, especially hospitals in COVID-19 hot spots, have begun implementing COVID-19 surgical pathways to help ease the surgical burden. The 2020 European Society of Surgical Oncology (ESSO)’s virtual summit opened our eyes to the inescapable fact that COVID-19 will reshape the face of surgical oncology.


Impact of COVID-19 on High-Income Regions

With the pandemic in full swing and cases ever on the rise, surgeons, particularly cancer surgeons, across the world are debating the necessities of implementing long-term change with operation scheduling, minimal person-to-person contact, and elective surgery cancellations. As expected, COVID-19 has resulted in a drastic reduction of surgical activity worldwide, with coronavirus hot spots Europe and the U.S. seeing massive reductions.


What Was the Cancer Surgery Burden in Europe’s Biggest Hotspot, Italy?

An elective oncological survey was conducted by Marco Montorsi, MD, and his team to understand how COVID-19 had affected surgical care of Italian cancer patients. The survey was sent to 54 surgical units in three stages: before, during, and after the first wave of the COVID-19 pandemic in March 2020.

During the peak of the first wave, the survey identified a clear reduction in the number of cancer resections scheduled per week, alongside:

  • 70% reduction in surgical beds
  • 76% reduction in surgical activity
  • Almost complete cancellation of outpatient surgeries

Also seen was a prolongation in the time-interval between cancer multidisciplinary team (MDT) discussions and the surgery itself. Disease biology, tumor aggressiveness, and interval from neoadjuvant treatments were the three primary criteria that defined the urgency of the surgery and thereby its need to be performed during the pandemic.


Dr. Montorsi stated that a follow-up elective survey is in the making to monitor the effects of the ongoing second wave. He explained that the aims of the second survey are “to investigate the impact of COVID-19 in surgical departments in the past months of heavy pandemic, understand outcomes of COVID-19 patients undergoing oncological surgery, and to investigate how many alternative treatments to surgery have been performed and how many of these are considered to be a bridge to surgery.”

Dr. Montorsi also highlighted that during the heat of the pandemic in Italy, surgeons tried to devise a new priority model for elective surgeries performed on cancer patients. They found that of the minimally invasive surgeries performed during the COVID-19 pandemic, liver and pancreatic cancer surgeries were vastly reduced but colorectal cancer surgery rates in Italy remained similar to previous years, showing that certain hospitals remained a safe environment to perform cancer surgeries in, if strict Personal Protective Equipment guidelines were followed.

However, as the pandemic continues to be a destructive force in the health care industry, an increasing number of surgeons are becoming unavailable to perform surgeries after contracting COVID-19. So, the large question remains, “How do we proceed?” Dr. Montorsi asked. In Italy alone, an estimated 400,000 cancer surgeries need reprogramming in the gap between the COVID-19 waves, and with more and more of the workforce becoming susceptible to COVID-19, this question really needs to be addressed sooner rather than later.


How Does the U.S. Compare to Italy?

Let’s look at the big picture. The U.S is now the worst COVID-19 affected country worldwide, with a total of 13.5 million cases and 268k deaths by December 1st 2020 and climbing. It is no surprise that cancer patients are suffering more and fighting harder to survive than they have ever before. The fight is real for everyone but increasing amounts of data show that cancer patients are more vulnerable to worsened outcomes if they contract SARS-CoV-2, which includes increased need for oxygenation via ventilation and raised infection-associated mortality.

Secondly, cancer patients are getting delayed diagnoses due to the decreased availability or suspension of diagnostic and screening services. This alone is terrifying because a patient’s diagnosis for their cancer stage and grade is the only way treatment can be determined. Additionally, pre-diagnosed but un-staged cancer patients are also reluctant to be screened because they do not want to risk contracting COVID-19. This effectively means that patients are being diagnosed later and later, thereby worsening their prognosis and increasing their fight for survival by 100-fold. Thirdly, pre-determined treatment options for patients prior to COVID-19 outbreaks have been altered or cancelled altogether depending on the rate of tumor progression, to free hospital bed availability for terminal or life-threatening COVID-19 patients and to minimize exposure to vulnerable immunosuppressed individuals like cancer patients during treatment or surgery. While this is done with careful consideration by the patients’ MDT, there is no guarantee that tumor progression is unaffected when the patient is not receiving treatment or is receiving an alternative treatment.


What Are the Implications for Cancer Surgery?

Capacity for surgery has been drastically reduced as operation theatre space and ventilators have been reallocated to provide for the critical care capacity of COVID-19 patients. Moreover, reports have shown that there is increased risk for contracting COVID-19 postoperatively for any non-COVID elective surgeries, making patients, especially vulnerable ones (i.e., cancer patients, immunosuppressed, and the elderly), more reluctant to undergo surgery in COVID-19 overflow hospitals. Studies conducted in China, Europe, and North America have shown that cancer patients, particularly lung-cancer patients, who contract COVID-19 have a higher risk of mortality, increased ICU admission risk, and severe clinical effects when compared to non-cancer COVID-19 patients. Additionally, a recent meta-analysis showed that all-cause mortality was significantly higher in cancer patients when compared to non-cancer patients, and similar to previous coronavirus outbreaks, the reported mortality rate was 84% in cancer patients compared to 39% in non-cancer patients, further demonstrating the vulnerability of cancer patients to the SARS-CoV-2 infection.

As a result, most MDT’s have opted to put their patients on neoadjuvant chemotherapy, radiotherapy, or hormonal therapy as therapeutic buffers until surgery become available again. However, these options are usually not effective as primary treatment options and therefore also increase the risk of cancer-associated mortality. In order to help oncologists and cancer surgeons navigate this complex field of decisions, the American College of Surgeons “has recommended that in early stages of the pandemic, semi-elective surgery, such as for nearly obstructing colon cancers, stenting for oesophageal cancers and most gynecological cancers, should continue.” In response, health care facilities like hospitals, cancer care centers, and surgical centers are trying to rapidly reorganize elective cancer procedures to ensure that cancer patients continue to receive all the essential care while minimizing their exposure to the deadly COVID-19 infection.



The COVID-19 pandemic has led to a catastrophic global disruption in the field of surgical oncology, severely delayed cancer diagnoses and treatment, and halted many ground-breaking surgical clinical trials. Many studies including Dr. Montorsi’s elective oncological survey, Mehta and Goel’s COVID-19 and cancer patient outcome, Rickards et al., study on COVID-19’s impact, have repeatedly tried to objectively quantify the impact of COVID-19 on cancer care. However, with the continuous progress of this pandemic, it has become impossible to gather data and understand the real-time effects on surgical care. While models are under development to try and ease this burden, much of the work to recenter surgical oncology remains to be done.

With the holiday season upon us, whether you meet with your family virtually or safely in person, keeping up to date on your health information and easily sharing it with your family members is a great gift. Additionally, knowledge about family health history is particularly important to understand your risk of colorectal cancer. During Thanksgiving and into the end of the year, take control of your and your family’s health information and consider joining The Colon Cancer Patient Registry on Backpack Health.

Aside from the physical challenges associated with colorectal cancer, managing the many health administrative aspects of a chronic disease is an added burden to the lives of patients and their caregivers. The Colon Cancer Foundation has recently announced a collaboration with Backpack Health, a Konica Minolta Service, to offer a solution that helps patients organize, share, and manage their health records. Living with a chronic illness doesn’t need to feel like a full-time job.

Similar to a real backpack, Backpack Health’s platform allows users to both portably store and access their health information via an app on iOS or Android phones, or via the website on a tablet or computer. Through the Colon Cancer Foundation’s group on Backpack Health, users living with colorectal cancer will be able to share their health information, including lab reports, information from their specialists, and medications, with designated family members and health care providers. All of the data users enter in Backpack Health is stored in the cloud, encrypted in Backpack’s database, and 256-bit encryption protects data sent over the network and secure HTTPS (HTTPS) sessions. To learn more about data security with Backpack Health you can visit here.

We have answered some frequently asked questions to help you get started with this new tool:


How do I join the Colon Cancer Foundation’s group?

You can join CCF’s group for FREE at


What is Backpack Health and how can it help me?

Backpack Health is a platform available on the web and in your mobile app store that can be used for storing your own and your family’s medical records, letting you access your health information anywhere and at any time. By having an organized location for your medical records, you can easily manage and share new information such as test results or care plans with your healthcare team and your family. Eliminating the administrative need of compiling records in a physical folder or journal can help keep your records secure and in one spot—to be accessed either on the website or the app.

Additionally, once you’ve made a data connection with your patient portal, you’ll see periodic notifications to review and add new data to your Backpack profile. The data connection scans for new information in your patient portal every few days, so you don’t have to worry about doing it yourself.


What are some important features of this tool?

You are in control of what information is shared, inputted, or viewed. As a user, you will have access to a user profile, where you can connect to your patient portals, include information about meal plans, medications, notes from your doctor, and so much more. Additionally, you can add family members, parents, or anyone you care for on your profile and include all of their health information, doctors’ contact information, etc.

Some features allow you to make personal notes or reminders to yourself, for when you visit your next specialist, for example. You can be reminded to ask your doctor if you can eat certain foods or use a certain product. Backpack Health is designed to make your health a priority, without consuming other aspects of your life.


Who can I share my information with?

 The Share Card feature on the platform puts you in charge of who sees your or your dependent’s health information. Some may choose to share their child’s health information with the school nurse or a new babysitter, with a family member that is accompanying you to a procedure, or even a friend you may be traveling with—the possibilities are entirely your choice, depending on what is best for you and your dependent’s health.

You have the option of creating a general health history Share Card and an emergency Share Card. You can also create custom Share Cards where you choose what information is displayed. The card can be shared as:

  • A secure URL
  • As a downloadable PDF


Are my healthcare providers able to edit my information?

No, your healthcare provider cannot edit your health information. However, you can create a data connection to your patient portal in order to pull in medical records that your provider has made available to you and store them in your Backpack profile.

You can also share parts or all of your health history with a new or existing provider by creating a Share Card and providing the URL and passcode to the person you want to review that information, or printing off a PDF.


What if English isn’t my first language?

Backpack Health is available for use in six languages (English, Spanish, French, Portuguese, Italian, and German), eliminating barriers between you and your health care team. This could also be a big advantage during international travel.


How will I know my health information will be secure?

Backpack Health explains on their security and privacy page that “All of the information you store on Backpack Health is encrypted. Information stored in the cloud is encrypted in our database, and 256-bit encryption protects data sent over the network and secure HTTP (HTTPS) sessions. Threat-detection services monitor Backpack Health’s systems continuously for unauthorized or malicious activity. And you can also keep your data extra safe on all of your devices by enabling two-factor authentication.”

Keeping your health information safe is a main priority.


What if I can’t figure out how to use Backpack Health?

No worries, you can watch this video, visit their website, or contact Backpack Health at!



– Describe yourself (Personal background, academic background, interests…)

I am a general surgery resident at Massachusetts General Hospital (MGH). I just completed two years (2018-2020) of dedicated research in the field of colorectal surgery and surgical oncology with a specific interest in colorectal cancer and surgical prehabilitation.

 I am originally from the California Bay Area but have done all of my education and training out east. My undergraduate years were spent at Johns Hopkins University and I subsequently received a Masters in Microbiology & Immunology from the Johns Hopkins Bloomberg School of Public Health. I graduated from Jefferson Medical College in 2015 with AOA distinction before heading up to Boston for my surgical training. I am now in the midst of my 6th of 7 years at MGH with plans to pursue a fellowship in colorectal surgery.


– Tell us about any awards and distinctions you have received

I have been fortunate to have received numerous prior awards for my research that has been presented at other regional and national meetings both in medical school and residency. In medical school, I was elected to AOA in my third year. In residency, I was named the General Surgery Consultant of the Year in 2018 by our MGH Emergency Medicine colleagues. My research work in prehabilitation was funded by an NIH T32 training grant and my NCT clinical trial is funded by numerous institutional grants.


– What made you interested in doing work in colon cancer?

Unfortunately, my family does have a history of colon cancer within it and I know firsthand the struggles that my family members have gone through. Therefore when I began residency, I had not originally believed that I would choose a career in colorectal surgery. However, once I rotated on our service here at MGH and interacted with the patients and was able to create personal connections with them based on shared experiences with this disease, I realized that this was my calling to treat these patients.


– Tell us about your past work and research efforts in the past and its significance to colon cancer

Much of my prior work was focused on colon cancer among octogenarians and how we can improve care for that population, which is significant given the growing number of aging citizens within this country paired with a longer lifespan. My latest work on this topic, which is to be published in Surgery next month, introduces the idea that older patients (>80) may have a different phenotype and both medical and surgical treatments may need to be tailored more specifically to their needs.


– Describe the current work you are conducting

 My current work is in surgical prehabilitation or “prehab” where I designed and am a co-investigator on a clinical trial purposed to investigate if exercise and nutritional prehabilitation benefits patients with gastrointestinal cancers. Specifically, we are investigating if these prescribed modalities improve surgical outcomes, survival, tumor biologics, and quality of life. The progress of our trial, unfortunately, got a bit derailed by the pandemic but we are hoping to restart this fall.


– What is your mission and goals in the current work that you are doing?

Currently, there is a time window between the date of colon cancer diagnosis and the date of surgery that is not being optimized to its full potential. My goal is to introduce prehab into this time window. During this time, we should be building our patient’s cardiopulmonary fitness and increasing their protein reserves in preparation for the stress of their surgery. Just as runners train for a marathon, we should be preparing our patients. My mission is to determine the optimal components of prehab, personalize them for individual patients, and ultimately prove the benefit that I believe exists.


– What are your goals for your future?

 My short-term goals are to successfully complete a residency in June 2022 followed by a fellowship in colorectal surgery. Long-term I plan to become an academic colorectal surgeon with both clinical and research pursuits that continuously try to improve care for patients with colon cancer.


– When did you first know that you wanted to work in this particular field of research, and why were you so passionate about that?

 As a former college athlete, I have always been interested in how I can intersect exercise and surgery. The concept of prehabilitation was speculated upon in some of my early readings in residency and I was fortunate to find a mentor who shared a passion for this topic. This helped me harness my focus and work on this particular field during my two years of dedicated research within residency.

While working on prehab and speculating on how exercise might be able to affect tumor biology, the topic of pathologic complete response (pCR) arose. We speculated, could exercise work synergistically with neoadjuvant therapy to promote a pCR? This is entirely pure speculation as there is currently no data to that exists to study this idea, however, it did spark my interest into pCR and led to the research project for which I received this award.


– For those who may not have the scientific background that you do, why is it so important that we all support the research being done in the field of colon cancer treatment and prevention?

It is tremendously important! Despite having great screening tools, colon cancer is the second leading cause of cancer death in this country. So much work is still left to be done and research support is critical so that physicians and scientists can continue to make improvements on how this disease is detected, treated, and ultimately prevented. 


– How has this award changed your life so far?

I am extremely grateful for this award. It has been incredibly beneficial for my career already in that it has sparked new acquaintances and conversations with other leaders and researchers of colon cancer. My hope is that some of these conversations turn into collaborations to help unite and synergize our efforts to fight this disease.


Media Contact: Cindy Borassi

Portchester, N.Y., November 19, 2020— The Colon Cancer Foundation, a 501(c)3 non-profit organization, is pleased to announce a unique partnership with Backpack Health, a Konica Minolta Service, to launch The Colorectal Cancer Patient Registry. This partnership allows colorectal cancer patients to securely track and manage their health data through iOS, Android, and web-based tools that enable easy sharing of medical information with health care providers, caregivers, and researchers.

Colorectal cancer patients need complex care to manage symptoms and eliminate the cancer from their body, often under the care of multiple specialists. Backpack Health’s secure mobile and web-based platform allows patients to streamline their medical information from different care providers, share with designated family members to improve care management, and reduce their burden of both managing health data and participating in research efforts to combat colorectal cancer.

“For people living with colorectal cancer, managing health information can feel like a full-time job. This partnership with Backpack Health will provide patients and caregivers a chance to have a stronger grasp on their diagnosis and treatment, which is really life-changing,” says Cindy Borassi, Interim President at the Colon Cancer Foundation.

By joining The Colorectal Cancer Patient Registry, Backpack Health users play an active role in their own care as well as research that can lead to newer treatments and improved quality of life for those affected by colorectal cancer.

The portable and concise nature of Backpack Health lends patients and their caregivers the flexibility of instant access to health records that can be readily shared with care teams via a Share Card. Additionally, the multilingual capabilities of Backpack Health’s platform can erase language barriers between health care providers, patients, and their loved ones.

“Backpack Health is excited to collaborate with The Colon Cancer Foundation, making it convenient and efficient for patients and their families to better manage and monitor their health, ” said Dr. Matthew Silva, Chief Executive Officer of Invicro and Board Member of Konica Minolta Precision Medicine. “We understand the importance and value to deliver useful and effective tools that can store, analyze, and share access to health records in real-time with providers and caregivers authorized by each patient.”

About the Colon Cancer Foundation

The Colon Cancer Foundation is a 501(c)3 non-profit organization registered in the state of New York and is listed by the IRS as a public charity. The organization is dedicated to supporting colorectal cancer research; educating the public about the importance of early detection, and forming strategic partnerships in the fight against colorectal cancer. The foundation offers those affected by colorectal cancer a platform to increase public awareness of colorectal cancer, while also working to lower incidence and death rates through public education, collaborations, and early-screening education. The Colon Cancer Foundation hosts annual events and challenges that seeks to raise money to support the foundation’s mission.

For more information please visit ( or connect with us on Instagram (, Facebook (, or twitter (

About Backpack Health

Backpack Health, a Konica Minolta Service, builds secure, innovative information tools to help people manage their health journey — including wellness, illnesses, injuries, and chronic health conditions. The Backpack Health mission is to make it easy for everyone to access, own and control their health information to support better health care and attain better health for themselves, their loved ones and their communities. Backpack Health provides a platform for organizations to engage patients, collect up-to-date data and build communities around the globe. The platform also bridges patient connection and medical data gaps offering pharmaceutical sponsors data access to accelerate their drug development research and clinical trials for novel diseases. To assure data protection for its users’ information, Backpack Health complies with the EU General Data Protection Regulation (GDPR), adheres to its data protection principles, and participates in the EU-U.S. and Swiss-U.S. Privacy Shield Frameworks and the advice in the light of recent changes to these frameworks. Learn more at

About Konica Minolta
Konica Minolta, Inc. (Konica Minolta) is a global digital technology company with core strengths in imaging and data analysis, optics, materials, and nano-fabrication. Through innovation, Konica Minolta creates products and digital solutions for the betterment of business and society—today and for generations to come. Across its Business Technologies, Healthcare, and Industrial-facing businesses, the company aspires to be an Integral Value Provider that applies the full range of its expertise to offer comprehensive solutions to the customer’s most pressing problems, works with the partners to ensure the solutions are sustainable, anticipates and addresses tomorrow’s issues, and tailors each solution to meet the unique and specific needs of its valued customers. Leveraging these capabilities, Konica Minolta contributes to productivity improvement and workflow change for its customers, and provides leading-edge service solutions in the IoT era. Headquartered in Tokyo and with operations in more than 50 countries, Konica Minolta has more than 43,000 employees serving approximately two million customers in over 150 countries. Konica Minolta is listed on the Tokyo Stock Exchange, (TSE4902). For further information, visit:

A shared decision-making tool is an approach that allows the clinician to collaborate with the patient in reaching evidence-informed decision making. This tool permits the patient and the physician to work together in order to make health care decisions based on the patient’s preferences and can ultimately strengthen the patient-clinician relationship. It plays a vital role in patient-centered health care, granting the physician and the patient an opportunity to be up with treatment plans together. 

According to the University of Utah Health Plans, shared decision-making tools have the ability to increase adherence to medical treatment, enhance decision making, which in turn will improve patient satisfaction. The significance of shared decision-making tools is reinforced by the chair of Population Health Sciences at University of Utah Health, Angie Fagerlin, Ph.D., who says, “If people don’t feel engaged in the decision-making process they are less likely to see the benefits of treatments. Instead, they may see them as a hassle and not fill their prescriptions or take the medications.”

The importance of a patient’s voice in regards to shared decision-making will help the physician gain a better understanding of their patient’s needs and preferences. The patient’s voice can be either active or passive.

  • The active voice is associated with the patient’s worries and what he/she requires in order to combat their disease
  • The passive voice is that of health-related information which is collected from the patient 

The patient’s voice is essential in terms of what he/she expects from their treatment plan. 

A couple of shared decision-making tools developed for metastatic breast cancer have enabled active patient participation in health care decisions. An example of such a tool is CONNECT, which is primarily used during a consultation between a physician and a patient. CONNECT is a computer-based communication tool that assesses the content covered during a consultation and treatment outcome expectations. A clinical trial evaluating the tool found that CONNECT made it easier for patients to participate in their respective treatment plans and therefore left them feeling more satisfied with the care they received. 

Patient Preferences for Prostate Care (PreProCare) is another tool that helps patient-centered treatment among prostate cancer patients. It allows patients to choose the treatment that they deem fit and that aligns with their values. This tool narrows down treatments for prostate cancer while giving patients the autonomy to choose based on their preferences. The tool works to identify the preferred features of prostate cancer treatments that will help in designing ways to help patients. The PreProCare tool improved patients’ 24-month satisfaction rate with care and decision and reduced regrets. 


As 2020 nears to a close, the COVID-19 pandemic in the United States has reached its 11-month mark, leaving many aspects of human life at a continued pause. While rescheduling weddings and graduations is rather possible, immunocompromised individuals do not have the choice to place aspects of their health care on hold. Immunocompromised individuals fear that they will come into contact with COVID-19 at a hospital or medical clinic, forcing many to neglect treatment plans, screenings, or check-ins with their care providers.

Cancer patients make up a large portion of the immunocompromised population in the world. During a presentation at the European Society of Surgical Oncology’s virtual conference, Marco Montorsi reported that elective cancer surgery in Italy has dropped by almost 76%, and most outpatient clinics have been completely cancelled. Though this reduction of elective oncological procedures has largely been influenced by the public’s collective deterrence of any health care facility, surgical oncologists support the notion that it is possible to engage in a safe surgical procedure, provided appropriate COVID-19 guidelines are followed.

Research conducted at a university hospital in Lombardy, Italy, compared postoperative outcomes of 2019 colorectal cancer (CRC) surgeries to those conducted during the peak COVID-19 period in 2020. Published in the British Journal of Surgery, the study showed that compared to 2019, the procedures done in 2020 actually had fewer or comparable postoperative complications. In other words, the peak of COVID-19 pandemic (February 23 to March 31) in Italy has fortunately caused no new harm to CRC patients undergoing surgery. Additionally, the reported length of stay was reduced by one day, going from an average of four days in 2019 to three in 2020.

While the hesitation of undergoing elective health care procedures during the pandemic seems justified, it is important to decipher the risks and benefits of such a decision, especially for cancer care, considering the impact of timely interventions on disease outcome. The researchers from Italy developed an oncologic case prioritization guideline that outlines both patient priority scale and selection criteria in order to determine if surgery is a priority, or if therapeutic alternatives may be an option. The rankings of urgency include:

  • Red (urgent)
  • Orange (deferrable urgency)
  • Yellow (potentially curative cancer surgery without alternatives)
  • Green (available therapeutic alternatives without compromising outcomes)

Given that oncological surgical centers and hospitals are adhering to COVID-19 research-based guidelines, cancer patients have safe options for continued care and treatment. Patients are encouraged to discuss any concerns with their primary care provider.

The anticipated draft recommendation from the U.S. Preventive Task Force Services (USPSTF) is here…and it brought forth great news for the colorectal cancer (CRC) community. This independent panel of experts has proposed lowering CRC screening age for average-risk adults from 50 to 45 years.

The B grade recommendation means private insurance plans must cover this preventive service without the individual paying anything out-of-pocket (no copayment, coinsurance, or deductible). A key provision of the Affordable Care Act is that private health insurance plans must cover preventive health care services recommended by expert medical bodies without cost-sharing.

Members of CCF’s Medical Advisory Council welcomed this recommendation.

Judy Yee, MD, FACR Chair of Radiology at the Albert Einstein College of Medicine and Montefiore Medical Center, said, “The new USPSTF draft guidelines will help to increase screening in patients younger than 50. Specifically, for individuals between the ages of 45-49, the B rating by the USPSTF indicates that colorectal cancer screening must be covered by private health plans.” Dr. Yee is a proponent of providing patients the option of validated screening tests such as CT colonography (virtual colonoscopy). “CT colonography is a structural exam, like colonoscopy, and can find polyps before they turn in to cancer, which is an advantage over the stool-based tests. Knowing about all the options is important and ultimately the best test is the one that actually gets done.”

Kimmie Ng, MD, MPH, Director of the Young-Onset Colorectal Cancer Center and Co-Director of the Colon and Rectal Cancer Center, Dana-Farber Cancer Institute, told CCF, “45 is the new 50!” Dr. Ng strongly believes that the revised screening age recommendation “is hugely impactful, will change standard of care in preventive medicine, and lead to insurance coverage of screening for people starting at age 45. However, research must continue into what the underlying causes of young-onset colorectal cancer are, as this new guideline will not benefit the many patients who are diagnosed younger than 45.”

Cindy Borassi, Interim President of the CCF, said, “The Colon Cancer Foundation applauds the USPSTF for taking a step in the right direction by lowering the screening-age recommendation for CRC screening. With early-age onset colon cancer a growing concern in both the U.S. and globally, initiating screening at 45 years instead of 50 among individuals with an average risk of CRC will lead to earlier diagnosis, potentially before the disease progresses to an advanced stage, which can dramatically improve patient outcomes. This is a significant boost to our foundation’s promise of raising awareness of the importance of early detection of CRC.”

A study published in JAMA Network Open earlier this year that analyzed CRC incidence in 1-year age increments found a steep rise in incidence among people in their early 50s, reflecting the large number of CRCs detected during first screening, which would be at the existing recommendation of 50 years. The proposed recommendation by USPSTF, once finalized, will help diagnose these early-onset cases much before they progress to an advanced stage.

It is important to remember that these are draft recommendations and the USPSTF is inviting stakeholders to provide comments till November 23, 2020. It is imperative that the CRC community prepare to spread the message on early screening within the population and primary care centers once the final recommendation is released early next year.

USPSTF has proposed lowering the screening age for CRC to 45! Lend your support and send in your comments directly to USPSTF by November 23.

Send Your Comment to USPSTF


As the nation moves towards a new era of inclusivity and diversity, the American Society of Clinical Oncology (ASCO)’s fourth annual survey sheds light on racial inequality and other issues that influence cancer screening and health care access amidst the COVID-19 pandemic.

ASCO’s National Cancer Opinion Survey is a largely accessible national representative survey conducted by The Harris Poll. The 2020 survey, conducted virtually from July 21st to September 8th, revealed that 4,012 U.S. adults aged 18 and older are suffering or have suffered from cancer in 2020 alone. ASCO President Lori Pierce, MD, FASTRO, FASCO said that “this survey assesses Americans’ perceptions of a wide range of cancer prevention and care issues during a most turbulent time in our country,” with the goal of addressing these needs within the context of access to cancer screening.

In line with the national racial equality crisis, and the Black Lives Matter Movement, this year’s survey placed a focus on understanding whether race can affect health care access. The survey found that 59% of Americans are aware of racial disparities impacting the care a person receives, with a majority of these views belonging to those in racial and ethnic minorities.

Figure 1: The Impact of Racism on Health Care Access. ASCO’s National Cancer Opinion Survey found that the majority of racial minorities (including Blacks, Hispanics, and Asians) argue that racism impacts the care an individual receives.

71% of respondents belonging to the Black ethnic group believe that they are less likely to receive the same quality of cancer care as Caucasians, while only 47% of Caucasians seem to agree with this belief. This large divide between the opinions of the two groups potentially stems from the fact that Caucasians aren’t overtly subjected to racial discrimination when it comes to their health care rights and quality of care, and they may subconsciously choose to believe that it does not exist. It could also be due to the lack of adequate information surrounding the extent of racial disparities within health care. This unconscious ignorance seen within the large majority of the American population needs to be resolved so that the nation can move forward to incorporate racial equality in cancer health care access.

Another prominent issue that ASCO has raised is the unequal distribution of good health care insurance within the population—56% of Americans argue that the type of health care insurance influences the likelihood of cancer survival. Additionally, despite increasing evidence showing worsened cancer prognosis in racial minorities, particularly for those belonging to the Black minority, fewer than 1 in 5 (19%) Americans actively believe that race impacts cancer survival, with Hispanic and Black respondents holding these views more than Whites.  Dr. Pierce argues that “racism undermines public health,” significantly affecting those suffering from cancer. She also states that “for almost every cancer, Black Americans fare worse than other racial groups” and that “now is the time to address the systemic issue of health inequity that negatively impact the health of Blacks and other people of color.”


Another surprising discovery from 2020’s National Cancer Opinion Survey is that a hefty two-thirds of Americans have either delayed or avoided their cancer screenings due to fear surrounding the COVID-19 pandemic. While pushing cancer screenings for a couple of months is not necessarily life-threatening, ASCO’s Chief Medical Officer Richard L. Schilsky, MD, FACP, FSCT, FASCO, is concerned that “a significant number of Americans might stop getting preventative care for long periods of time or altogether,” inevitably causing a drastic surge in cancer-associated morbidity and mortality. Though screenings may seem subjectively avoidable during a global pandemic, cancer can be well managed through screening—data shows that a majority of cancer-related deaths could be prevented with early screening and diagnostic measures.

Figure 2: Incorporation of Cancer Prevention Behaviors into Routine life. The National Cancer Opinion Survey conducted by ASCO consistently reports that a large proportion of the population do not include cancer prevention behaviors (usage of sunblock, healthy weight, and limited alcohol consumption) into their daily schedules.

Simultaneous to increased delays in cancer screenings, previous ASCO National Cancer Opinion surveys have also reported that most Americans are not incorporating cancer prevention behaviors into their regular schedules. For instance, less than half of the respondents use sunblock, maintain a healthy weight, or limit alcohol consumption, thereby increasing their cancer risk. While these cancer prevention steps may not seem that important in light of the current global situation, they are vital to reducing an individual’s risk of developing cancer. Therefore, researchers, oncologists, medical doctors, and other health care professionals strongly recommend incorporating these behaviors into daily routines.

To conclude, this year’s National Cancer Opinion Survey conducted by ASCO uncovers several issues within the American health care system, namely unequal access to cancer screenings due to racial disparities, cancer screening denial, and fear of developing COVID-19. In light of recent events and unprecedented circumstances, researchers and health care professionals now more than ever argue that it is imperative to proactively find solutions to these issues to better transform the future of the American health care system.

The U.S. Preventive Services Task Force (USPSTF)—which is made up of an independent expert physician panel who recommend preventive care guidelines—has proposed initiating colorectal cancer (CRC) screening at 45 years for average-risk adults. This is a B grade recommendation. Screening for those between 50 and 75 years remains an A grade recommendation and screening for the 76 to 85 age group is a C grade recommendation.

An A grade recommendation means there is high certainty of a substantial net benefit, a B grade recommendation means that there is a high certainty of a moderate net benefit or a moderate certainty of a moderate net benefit, and a C grade recommendation means the service should be offered based on professional judgement and an individual patient’s situation because there is a moderate certainty of a small net benefit.

Task Force chair Alex Krist, MD, MPH, said, “Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives. We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people’s risk of dying from this disease.” The Task Force has particularly recognized the disproportionately high number of CRC incidence and mortality among Black Americans and has urged physicians to offer this screening to their Black patients starting 45 years.

Both direct visualization (colonoscopy, CT colonography, flexible sigmoidoscopy, and flexible sigmoidoscopy with FIT) and stool-based tests (HSgFOBT, FIT, and sDNA-FIT) are included in the screening recommendation.

The draft recommendation is open for public comment till November 23.