The impact of COVID-19 on clinical practices of colorectal cancer in South Korea

Kwang Woo Kim; Hyoun Woo Kang

doi:10.5217/ir.2025.00005

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Editorial Tumor The impact of COVID-19 on clinical practices of colorectal cancer in South Korea: Kwang Woo Kim, Hyoun Woo Kang^,; Intestinal Research 2025;23(1):6-7.
DOI: https://doi.org/10.5217/ir.2025.00005
Published online: January 24, 2025

Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

Correspondence to Hyoun Woo Kang, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea. E-mail: gangmali@naver.com

• Received: January 18, 2025 • Accepted: January 21, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

See the article "The impact of the COVID-19 pandemic on clinical practices related to colorectal cancer and colonoscopy in South Korea: a nationwide population-based study" on page 85.

The coronavirus disease 2019 (COVID-19) pandemic, an unprecedented global crisis, has surged nationwide, limiting daily life of the population [1]. It has severely disrupted healthcare systems worldwide, including colorectal cancer (CRC) screening and management. The American Gastroenterological Association and Korean Cancer Association guidelines recommend postponing all elective procedures for asymptomatic patients due to concerns about COVID-19 and ensuring the efficient allocation of medical resources during the pandemic [2,3]. A recent study by Yoon et al. [4] offers critical insights into how the South Korean healthcare system adapted to these challenges. This study is the first to present comprehensive, real-world data on the impact of the pandemic on CRC-related clinical practices in South Korea. Using the Health Insurance Review and Assessment database, Yoon et al. [4] analyzed diagnostic and therapeutic colonoscopy volumes, CRC surgeries, and related treatments from 2019 to 2021. Their findings demonstrated a sharp decline in CRC-related procedures during the pandemic’s early months, followed by a prominent recovery within a year. Notably, therapeutic colonoscopies in 2021 exceeded pre-pandemic levels by 37.7%, a testament to the resilience of South Korea’s healthcare infrastructure.

These findings have several important clinical implications. First, the rapid recovery of CRC-related clinical practices underscores the importance of adaptable healthcare systems. South Korea’s decision to avoid prolonged lockdown and implement strict infection control measures probably mitigated the pandemic’s impact on CRC management. This adaptive strategy can serve as a model for other nations facing similar crises. Its repeated implementation within the country further strengthened and enhanced the safety of this approach [5]. Second, the data reveal a critical phenomenon: delays in CRC screening and treatment, even if short-term, can have profound downstream effects, including potential stage shifts and increased mortality. This study’s evidence of a rapid resurgence in colonoscopy volume post-pandemic highlights the necessity of maintaining procedural capacity during public health emergencies to prevent long-term oncological consequences. According to the latest post-polypectomy colonoscopic surveillance guidelines in various countries, including South Korea, the shortest recommended interval is 2–6 months [6,7]. Yoon et al. [4] reported that the monthly therapeutic colonoscopic volume recovered within 3 months, from March 2020 to June 2020, which could cover the surveillance intervals.

The strength of this study lies in its robust population-based design and use of high-quality administrative data, providing virtually unbiased and generalizable results. By documenting sex-specific differences in healthcare behaviors and emphasizing the role of government policies, this study contributes to our understanding of pandemic-induced healthcare disparities and recovery trajectories.

Despite its strengths, this study has several limitations. Reliance on administrative data introduces potential miscoding and lacks granular clinical details, such as CRC staging and patient outcomes. Future studies should aim to correlate procedural delays with stage-specific CRC outcomes and survival rates to fully quantify the pandemic’s impact. Additionally, these findings may not be generalizable to countries with different healthcare systems or pandemic responses. Comparative studies across diverse healthcare contexts are necessary to identify universally effective strategies to mitigate disruptions in cancer care.

Future research should build on these findings by addressing several key areas. First, longitudinal are needed to determine the long-term impact of the pandemic on CRC survival and recurrence rates. Second, the role of digital health interventions such as telemedicine, mobile health applications, and mailed fecal immunochemical tests should be explored for maintaining CRC screening during crises. These approaches have been repeatedly discussed in a previous article by Han [8]. Third, the effectiveness of various governmental strategies in minimizing healthcare disruptions warrants further exploration. Finally, behavioral studies to understand patients’ and providers’ perceptions of safety during pandemics may be needed to enhance adherence to CRC screening and treatment protocols.

This study provided a critical foundation for understanding the resilience of CRC clinical practices during the COVID-19 pandemic. These findings emphasize the need for adaptive healthcare strategies, robust procedural capacities, and datadriven policy interventions. Such insights are invaluable for safeguarding cancer care and improving patient outcomes globally in preparation for future pandemics.

NOTES

Funding Source

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

Kang HW is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Data Availability Statement

Not applicable.

Author Contributions

Conceptualization: Kim KW, Kang HW. Supervision: Kang HW. Writing-original draft: Kim KW, Kang HW. Writing - review & editing: Kim KW, Kang HW. Approval of final manuscript: Kim KW, Kang HW.

REFERENCES

1. Kim JY, Choe PG, Oh Y, et al. The first case of 2019 novel coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. J Korean Med Sci 2020;35:e61.Article PubMed PMC PDF
2. Sultan S, Lim JK, Altayar O, et al. AGA rapid recommendations for gastrointestinal procedures during the COVID-19 pandemic. Gastroenterology 2020;159:739–758.Article PubMed PMC
3. Lee JB, Jung M, Kim JH, et al. Guidelines for cancer care during the COVID-19 pandemic in South Korea. Cancer Res Treat 2021;53:323–329.Article PubMed PMC PDF
4. Yoon JY, Lee MH, Kwak MS, Cha JM. The impact of the COVID-19 pandemic on clinical practices related to colorectal cancer and colonoscopy in South Korea: a nationwide population-based study. Intest Res 2025;23:85–95.Article PubMed PDF
5. Kang HS, Jeon SH, Park SB, Youn JY, Kwak MS, Cha JM. The elderly population are more vulnerable for the management of colorectal cancer during the COVID-19 pandemic: a nationwide, population-based study. Intest Res 2023;21:500–509.Article PubMed PMC PDF
6. Kim SY, Kwak MS, Yoon SM, et al. Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition. Intest Res 2023;21:20–42.Article PubMed PMC PDF
7. Jung YS. Summary and comparison of recently updated postpolypectomy surveillance guidelines. Intest Res 2023;21:443–451.Article PubMed PMC PDF
8. Han YM. To overcome medical gap in screening and surveillance of colorectal cancer during the COVID-19 pandemic. Intest Res 2023;21:418–419.Article PubMed PMC PDF

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