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
| Autor: | Amit Sud, Mark Lawler, John Broggio, Elio Riboli, David C. Muller, Alice Garrett, Muti Abulafi, Firza Gronthound, Ethna McFerran, Emma Kipps, Stephen Scott, Matthew Williams, Clare Turnbull, Richard S. Houlston, Beth Torr, David Nicol, Stephen A. Boyce, Michael Jones, Georgios Lyratzopoulos, Claire Barry, Chey Loveday, Shaman Jhanji |
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| Přispěvatelé: | Cancer Research UK |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
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 |
| Zdroj: | 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 |
| DOI: | 10.1136/gutjnl-2020-321650 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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