Short‐term outcomes of a COVID‐adapted triage pathway for colorectal cancer detection

Janice Miller, Yasuko Maeda, Stephanie Au, Frances Gunn, Lorna Porteous, Rebecca Pattenden, Peter Maclean, Colin L Noble, Stephen Glancy, Malcolm G Dunlop, Farhat V N Din

Research output: Contribution to journalArticlepeer-review

Abstract

Aim
The dramatic curtailment of endoscopy and CT colonography capacity during the coronavirus pandemic has adversely impacted timely diagnosis of colorectal cancer (CRC). We describe a COVID-adapted diagnostic pathway, rapidly implemented, to mitigate risk and maximise cancer diagnosis in patients referred with symptoms of suspected CRC.
Methods
The “COVID-adapted pathway” integrated multiple quantitative faecal immunochemical tests (qFIT) to enrich for significant colorectal disease with judicious use of CT with oral contrast to detect gross pathology. Patients reporting ‘high-risk’ symptoms were triaged to qFIT+CT and the remainder underwent an initial qFIT to inform subsequent investigation. Demographic and clinical data was prospectively collected. Outcomes comprised cancer detection frequency.
Results
Overall 422 patients (median age 64 years, 220 females) were triaged using this pathway. Most (84·6%) were referred as ‘urgent suspicious of cancer’. Of the 422 patients, 202 (47·9%) were triaged to CT and qFIT, 211 (50·0%) to qFIT only, eight (1·9%) to outpatient clinic, and one to colonoscopy. Fifteen (3·6%) declined investigation and seven (1·7%) were deemed unfit. We detected 13 cancers (3·1%); similar to the mean cancer detection rate from all referrals in 2017-2019 (3·3%). Compared to 1st April – 31st May in 2017-2019, we observed a 43% reduction in all primary care referrals (1071 referrals expected reducing to 609).
Conclusion
This COVID-adapted pathway mitigated the adverse effects of diagnostic capacity and detected the expected cancer rate within those referred. However, the overall reduction in number of referrals was substantial. The described risk mitigating measures could be a useful adjunct whilst standard diagnostic services remain constrained due to the ongoing pandemic.
Original languageEnglish
JournalColorectal Disease
Early online date7 Mar 2021
DOIs
Publication statusE-pub ahead of print - 7 Mar 2021

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