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Starting in 2020 and continuing for 2 years thereafter, the COVID-19 pandemic has greatly affected routine clinical practice, particularly in treating patients with gastrointestinal cancer. Delay, postponement or refusal to continue multimodal treatment have increased the number of emergency cases, and consequently patient morbidity and mortality.

Many recommendations have been announced to guide the adaptation of clinical practice during and after the COVID-19 pandemic. Although early diagnosis and screening should proceed as usual before the pandemic, adjuvant treatment for patients with gastrointestinal cancer should be evaluated in the future. For example, during the pandemic, most recommendations state that adjuvant treatment for patients with colorectal cancer is still required, and many adaptations have been suggested according to local conditions.

In some instances, 6 months of adjuvant chemotherapy has been modified to an optional 3 month duration. A common challenge is that most patients remain unsure about the decreased chemotherapy duration, although many guidelines recommend this modified treatment strategy. Short term follow up has already indicated promising clinical outcomes of this modified adjuvant duration, but the long-term outcomes remain to be evaluated.