Adoption of faecal immunochemical testing for 2‐week‐wait colorectal patients during the COVID‐19 pandemic: an observational cohort study reporting a new service at a regional centre

MacLean, William C.; Limb, Chris; Mackenzie, Paul; Whyte, Martin; Benton, Sally C; Rockall, Timothy; Jourdan, Iain

doi:10.1111/codi.15408

Cited by 23 publications

(24 citation statements)

References 21 publications

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“…94% of samples were returned, of which 34% were interpreted and positive and were followed by colonoscopy. The CRC diagnosis rate with this pathway was 3.7% (14 CRC of 122 colonoscopies), comparable to the pre-COVID detection rate of 3.9% [31]. Miller et al triaged referred patients to alternate testing modalities of FIT with CT scan, FIT only, direct colonoscopy or clinical follow up.…”

Section: Triage and Alternate Screening Pathwaysmentioning

confidence: 84%

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions

et al. 2021

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The COVID-19 pandemic has impacted all aspects of medical care, including cancer screening and preventative measures. Colorectal cancer screening declined significantly at the onset of the pandemic as the result of an intentional effort to conserve resources, prioritize emergencies and reduce risk of transmission. There has already been an increase in diagnosis at more advanced stages and symptomatic emergencies due to suspended screenings. As endoscopy units find their way back to pre-pandemic practices, a backlog of cases remains. The missed CRC diagnoses amongst the missed screenings carry a risk of increased morbidity and mortality which will only increase as time-to-diagnosis grows. This review discusses the impact of COVID-19 on colonoscopy screening rates, trends in stages/symptoms/circumstances at diagnosis, and economic and social impact of delayed diagnosis. Triaging and use of FITs are proposed solutions to the challenge of catching up with the large number of pandemic-driven missed CRC screenings.

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Section: Triage and Alternate Screening Pathwaysmentioning

confidence: 84%

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions

et al. 2021

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“…With the COVID‐19 pandemic reducing access to endoscopy, FIT was recommended for triage by NHS England for those within the higher risk groups [26]. The RSFT demonstrated that using FIT enabled safety‐netting with a watch and wait approach, but also reduced overall colonoscopy from 62% to 34% of TWW patients [27].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of point of care faecal immunochemical testing using a portable high‐speed quantitative analyser for diagnosis in 2‐week wait patients

et al. 2021

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Aim Laboratory‐based faecal immunochemical testing (FIT) is the gold standard for detecting the presence of blood in the stool. The aim was to perform a diagnostic accuracy study to confirm if a point of care (POC) analyser for FIT could be safely used as an adjunct in the triage and management of 2‐week wait (TWW) colorectal patients. Methods The Point of Care Faecal Immunochemical Testing (POC FIT) prospective observational cohort study was designed for TWW patients at a regional referral centre. Between July 2019 and March 2020, patients were invited to perform and bring a FIT sample to clinic. FIT was completed within the clinic appointment using a POC quantitative analyser that has a 2‐min processing time (QuikRead go®). Patients and clinicians were blinded to results within the clinic appointment. The results were compared with subsequent diagnostic outcomes. Faecal haemoglobin of <10 µg haemoglobin/g of faeces was considered a negative result. Sensitivities for colorectal cancer (CRC) and combined serious bowel disease (SBD) were calculated using this pre‐determined cut‐off. Results A total of 553 patients were included for analytical comparison with diagnostic outcomes. There were 14 (2.5%) patients with CRC and 52 (9.4%) with SBD. The sensitivities for CRC and SBD were 92.9% (95% CI 68.5%–98.7%) and 76.9% (95% CI 63.9%–86.3%) respectively. 379 (68.5%) patients had a negative FIT result (negative predictive value for CRC was 99.7%). Conclusions This POC FIT device is a useful adjunct to better manage TWW patients. The high observed sensitivity for CRC offers opportunities, within a single consultation, for improved triage and rationalization of investigation for those with bowel symptoms.

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“…Maclean et al demonstrated FIT results could be obtained in over 94% of referrals by sending the kit directly to patients and, using a 10 μgHb/g cut-off, a half of the patients were excluded from further investigations. 16 If this were applied in our cohort, 35.7% of the patients with an FIT result would have been excluded. We believe FIT testing should be considered imperative for all 2ww referrals without a mass or rectal bleeding, and we recognise this was recommended by a recent independent review of diagnostic services for NHS England.…”

Section: Discussionmentioning

confidence: 99%

Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway

Archer

Aziz

Kurien

et al. 2021

Frontline Gastroenterol

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ObjectiveThe 2-week-wait (2ww) referral pathway is used in England to fast-track patients with suspected colorectal cancer (CRC). A two-stage triage pathway was used to prioritise lower gastrointestinal (LGI) endoscopy for suspected CRC during the COVID-19 pandemic.MethodAll patients referred for an LGI endoscopy via a 2ww referral pathway between March 2020 and July 2020 were assessed. The first stage triaged patients to high, standard or low risk of CRC based on symptoms and faecal immunochemical test (FIT), and offered CT scans to those at high risk. The second stage, endoscopy prioritisation (EP), incorporated the CT results, FIT and symptoms to triage into four groups, EP1–EP4; with EP1 being the most urgent and EP4 the least. The primary outcome measure was CRC detection.Results514 patients were included. The risk of CRC was triaged as high in 190/514 patients (37%), standard in 274/514 patients (53%) and low in 50/514 (10%) patients. 422/514 patients (82%) underwent endoscopy with triage to EP1 in 52/422 (12%), EP2 in 105/422 (25%), EP3 in 210/422 (50%) and EP4 in 55/422 (13%). CRC was detected in 23 patients (5.4%). CRC was significantly more frequent in the EP1 group (23.1%, relative risk (RR)=16.2) and EP2 group (6.7%, RR=4.7) compared with EP3 group (1.4%). All CRC lesions were identified by CT imaging when performed prior to LGI endoscopy.ConclusionThis triage pathway designated 83% of patients with CRC to either EP1 or EP2. During a period of limited endoscopy provision, this pathway effectively prioritises endoscopy for those at greatest risk of CRC.

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Adoption of faecal immunochemical testing for 2‐week‐wait colorectal patients during the COVID‐19 pandemic: an observational cohort study reporting a new service at a regional centre

Cited by 23 publications

References 21 publications

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions

Diagnostic accuracy of point of care faecal immunochemical testing using a portable high‐speed quantitative analyser for diagnosis in 2‐week wait patients

Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway

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