About: 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

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About: 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 Goto Sponge NotDistinct Permalink

An Entity of Type : schema:ScholarlyArticle, within Data Space : covidontheweb.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	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
Creator	Jones, Michael Muller, David Williams, Matthew Abulafi, Muti Barry, Claire Boyce, Stephen Broggio, John Garrett, Alice Gronthound, Firza Houlston, Richard Jhanji, Shaman Kipps, Emma Lawler, Mark Loveday, Chey Lyratzopoulos, Georgios Nicol, David Riboli, Elio Scott, Stephen Sud, Amit Torr, Beth Turnbull, Clare Mcferran, Ethna
Source	Medline; PMC
abstract	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 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. 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 µg 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.
has issue date	2020-08-24(xsd:dateTime)
bibo:doi	10.1136/gutjnl-2020-321650
bibo:pmid	32855306
has license	cc-by
sha1sum (hex)	3ed438dde9772c4954165847cf04f8ddbae7a408
schema:url	https://doi.org/10.1136/gutjnl-2020-321650
resource representing a document's title	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
has PubMed Central identifier	PMC7447105
has PubMed identifier	32855306
schema:publication	Gut
resource representing a document's body	covid:3ed438dde9772c4954165847cf04f8ddbae7a408#body_text
is schema:about of	named entity 'Delays' named entity 'CRC' named entity 'streamline' named entity 'faecal' named entity 'referred' named entity 'case' named entity 'wait' named entity 'immunochemical' named entity 'sensitive' named entity '4/6' named entity 'construct' named entity 'delays' named entity 'colorectal cancer' named entity 'employed' named entity 'life' named entity 'FIT' named entity 'patients' named entity 'FIT' named entity 'England' named entity 'colorectal cancer' named entity 'COVID-19' named entity '2WW' named entity 'triage' named entity 'nosocomial' named entity 'colorectal cancer' named entity 'endoscopy' named entity 'colonoscopy' named entity 'primary care' named entity 'colonoscopy' named entity 'survival' named entity 'triage' named entity 'COVID-19' named entity 'nosocomial infection' named entity 'COVID-19' named entity 'COVID-19' named entity 'anxiety' named entity 'COVID-19 pandemic' named entity 'nosocomial' named entity 'secondary care' named entity 'Office of National Statistics' named entity 'nosocomial' named entity 'British Society of Gastroenterology' named entity 'critical care unit' named entity 'nosocomial infection' named entity 'healthcare services' named entity '2WW' named entity 'nosocomial infection' named entity 'rectal cancer' named entity 'aerosol' named entity 'nosocomial infection' named entity 'risk-benefit analysis' named entity 'endoscopic' named entity 'asymptomatic' named entity 'nosocomially' named entity '2WW' named entity 'asymptomatic patients' named entity '2WW' named entity 'British Society of Gastroenterology' named entity 'tumour stage' named entity 'high-risk'

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