期刊
GUT
卷 70, 期 6, 页码 1053-1060出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/gutjnl-2020-321650
关键词
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资金
- Institute for Cancer Research
- National Institute for Health Research (NIHR)
- Biomedical Research Centre (BRC)
- Breast Cancer Now
- Cancer Research UK award [C61296/A27223]
- Movember Foundation [MOV004X]
- Cancer Research UK [C57955/A24390, C8640/A23385, C1298/A8362]
- Bobby Moore Fund for Cancer
- Cancer Research UK Advanced Clinician Scientist Fellowship Award [C18081/A18180]
- Stratified Medicine in Colorectal Cancer Grant (Medical Research Council/Cancer Research UK)
- Health Data Research UK (HDR-UK)'s DATA-CAN
- UK Health Data Research Hub for Cancer [NIWA1]
- Queen's University Belfast Foundation
- Cancer Focus Northern Ireland
- National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC)
- HDR-UK MRC Rutherford Fellow award [MR/S003789/1]
- MRC [MC_PC_19006] Funding Source: UKRI
This study evaluated the impact of faecal immunochemical testing (FIT) prioritisation to mitigate delays in the colorectal cancer (CRC) urgent diagnostic pathway caused by the COVID-19 pandemic. The results indicated that prioritisation of FIT testing could reduce mortality and loss of life years for CRC patients, especially for older patients.
Objective To 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. Design We 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 mu g 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. Results Delay 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 mu g Hb/g would avoid 89% of these deaths attributable to presentational/diagnostic delay while reducing immediate requirement for colonoscopy by >80%. Conclusions Delays 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.
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