| Autor: |
Lincoln, Anne G, Benton, Sally C, Piggott, Carolyn, Sheikh, Shama Riaz, Beggs, Andrew D, Buckley, Leah, DeSouza, Bianca, East, James E, Sanders, Pete, Lim, Michael, Sheehan, Donal, Snape, Katie, Hanson, Helen, Greenaway, John R, Burn, John, Nylander, David, Hawkins, Menna, Lalloo, Fiona, Green, Kate, Lee, Thomas J |
| Předmět: |
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| Zdroj: |
BJS Open; Oct2023, Vol. 7 Issue 5, p1-8, 8p |
| Abstrakt: |
Background: Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented during the COVID-19 pandemic utilizing faecal immunochemical testing ('FIT') in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited. Methods: An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg of haemoglobin/g of faeces (µg/g)—scheduled within 6–12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g—triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance. Results: Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10 µg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001). Conclusion: Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the 'FIT for Lynch' study (ISRCTN15740250). This was an emergency service protocol designed to improve access to colonoscopy using faecal immunochemical testing for risk-stratified triage during the height of the COVID-19 pandemic for people with Lynch syndrome when endoscopy services were extremely limited. Requests for faecal immunochemical testing for eligible Lynch syndrome patients were made by participating National Health Service Trusts, which triggered the sending of a faecal immunochemical testing kit, faecal immunochemical testing instructions, a paper-based survey, and pre-paid return envelope from the National Health Service Bowel Cancer Screening South of England Hub in Surrey to said patients, and risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg/g—schedule colonoscopy within 6–12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g—triage via an urgent suspected cancer clinical pathway. For 339 participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (177.0 per cent) met criteria for urgent triage (faecal haemoglobin greater than or equal to 10 µg/g), with escalation to colonoscopy facilitated in the latter group of patients, with a median wait of 49 days (versus 122 days for f-Hb less than 10), demonstrating the clinical value of faecal immunochemical testing for patients with Lynch syndrome requiring colorectal cancer surveillance during the pandemic. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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