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Prioritisation by FIT to mitigate the impact of delays in the 2-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study
- Source :
- Loveday, C, Sud, A, Jones, M E, Broggio, J, Scott, S, Gronthound, F, Torr, B, Garrett, A, Nicol, D L, Jhanji, S, Boyce, S A, Williams, M, Barry, C, Riboli, E, Kipps, E, McFerran, E, Muller, D C, Lyratzopoulos, G, Lawler, M, Abulafi, M, Houlston, R S & Turnbull, C 2020, ' Prioritisation by FIT to mitigate the impact of delays in the 2-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study ', Gut . https://doi.org/10.1136/gutjnl-2020-321650, Gut
- Publication Year :
- 2020
-
Abstract
- ObjectiveTo evaluate the impact of faecal immunochemical testing (FIT) prioritisation to mitigate the impact of delays in the colorectal cancer (CRC) urgent diagnostic (2-week-wait (2WW)) pathway consequent from the COVID-19 pandemic.DesignWe modelled the reduction in CRC survival and life years lost resultant from per-patient delays of 2–6 months in the 2WW pathway. We stratified by age group, individual-level benefit in CRC survival versus age-specific nosocomial COVID-19–related fatality per referred patient undergoing colonoscopy. We modelled mitigation strategies using thresholds of FIT triage of 2, 10 and 150 µg Hb/g to prioritise 2WW referrals for colonoscopy. To construct the underlying models, we employed 10-year net CRC survival for England 2008–2017, 2WW pathway CRC case and referral volumes and per-day-delay HRs generated from observational studies of diagnosis-to-treatment interval.ResultsDelay of 2/4/6 months across all 11 266 patients with CRC diagnosed per typical year via the 2WW pathway were estimated to result in 653/1419/2250 attributable deaths and loss of 9214/20 315/32 799 life years. Risk–benefit from urgent investigatory referral is particularly sensitive to nosocomial COVID-19 rates for patients aged >60. Prioritisation out of delay for the 18% of symptomatic referrals with FIT >10 µg Hb/g would avoid 89% of these deaths attributable to presentational/diagnostic delay while reducing immediate requirement for colonoscopy by >80%.ConclusionsDelays in the pathway to CRC diagnosis and treatment have potential to cause significant mortality and loss of life years. FIT triage of symptomatic patients in primary care could streamline access to colonoscopy, reduce delays for true-positive CRC cases and reduce nosocomial COVID-19 mortality in older true-negative 2WW referrals. However, this strategy offers benefit only in short-term rationalisation of limited endoscopy services: the appreciable false-negative rate of FIT in symptomatic patients means most colonoscopies will still be required.
- Subjects :
- medicine.medical_specialty
Delayed Diagnosis
Referral
Colorectal cancer
Colonoscopy
colorectal cancer
colorectal cancer screening
Risk Assessment
03 medical and health sciences
0302 clinical medicine
SDG 3 - Good Health and Well-being
medicine
Humans
Infection control
Life Tables
Mortality
Early Detection of Cancer
Cross Infection
Infection Control
Gastroenterology & Hepatology
medicine.diagnostic_test
SARS-CoV-2
business.industry
Immunochemistry
Gastroenterology
COVID-19
Cancer
1103 Clinical Sciences
medicine.disease
Triage
United Kingdom
GI cancer
Occult Blood
030220 oncology & carcinogenesis
Emergency medicine
Critical Pathways
1114 Paediatrics and Reproductive Medicine
030211 gastroenterology & hepatology
Observational study
Colorectal Neoplasms
Risk assessment
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Loveday, C, Sud, A, Jones, M E, Broggio, J, Scott, S, Gronthound, F, Torr, B, Garrett, A, Nicol, D L, Jhanji, S, Boyce, S A, Williams, M, Barry, C, Riboli, E, Kipps, E, McFerran, E, Muller, D C, Lyratzopoulos, G, Lawler, M, Abulafi, M, Houlston, R S & Turnbull, C 2020, ' Prioritisation by FIT to mitigate the impact of delays in the 2-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study ', Gut . https://doi.org/10.1136/gutjnl-2020-321650, Gut
- Accession number :
- edsair.doi.dedup.....83c72569aaed0148e80088de9eefa6ff