Straight‐to‐test colonoscopy for 2‐week‐wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high‐volume unit

Banerjea, Ayan; Voll, Jessika; Chowdhury, Abeed H.; Siddika, Arifa; Thomson, Samantha; Briggs, R; Humes, David J.

doi:10.1111/codi.13667

Cited by 24 publications

(29 citation statements)

References 14 publications

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“…Of these, 1655 were excluded because they were not conducted in the UK or were not in accordance with NICE guidance. The full texts of the remaining 95 records were reviewed, of which 49 were included in the review . Of the 49 included publications, one reported two datasets from different centres .…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Mozdiak

Ghebremichael‐Weldeselassie

McFarlane

et al. 2019

Aliment Pharmacol Ther

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Summary Background National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site‐specific fast‐track (2‐week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. Aims To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2‐week wait pathway. Methods A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta‐analysis; heterogeneity was assessed by I2. Results Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9‐8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4‐15.6), B = 36.7% (95% CI 30.8‐42.8), C = 35.7% (95% CI: 30.8‐40.8) and D = 11.1% (95% CI 7.3‐15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2‐62.8). Conclusions Only 7.7% of patients referred by the 2‐week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non‐2‐week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2‐week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.

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Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Mozdiak

Ghebremichael‐Weldeselassie

McFarlane

et al. 2019

Aliment Pharmacol Ther

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“…Interventions to improve colonoscopy access include novel referral systems and alternative provider models. In the United Kingdom, rapid diagnostic pathways using direct access or nurse-based triage reduced colonoscopy waiting time and were cost-effective (49,50). Alternative colonoscopy provider models may also improve access, with both nurse and PCP-delivered endoscopy having evidence of quality and safety (51,52), including in rural areas (53).…”

Section: Discussionmentioning

confidence: 99%

Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer

Bergin

Emery

Bollard

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Longer cancer pathways may contribute to rural-urban survival disparities, but research in this area is lacking. We investigated time to diagnosis and treatment for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Population-based surveys (2013-2014) of patients (aged ≥40, approached within 6 months of diagnosis), primary care physicians (PCPs), and specialists were collected as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were examined: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment), and total interval (symptom/screening to treatment). Rural and urban intervals were compared using quantile regression including age, sex, insurance, and socioeconomic status. 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs, and 370 specialists participated. Compared with urban patients, patients with symptomatic colorectal cancer from rural areas had significantly longer total intervals at the 50th [18 days longer, 95% confidence interval (CI): 9-27], 75th (53, 95% CI: 47-59), and 90th percentiles (44, 95% CI: 40-48). These patients also had longer diagnostic and health system intervals (6-85 days longer). Breast cancer intervals were similar by area of residence, except the patient interval, which was shorter for rural patients with either cancer in the higher percentiles. Rural residence was associated with longer total intervals for colorectal but not breast cancer; with most disparities postpresentation. Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities. .

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“…We have previously described our straight to test (STT) pathway and our FIT pilot . A number of locally agreed modifications were required to integrate FIT into clinical pathways (Appendix in the online Supporting Information): Primary care colleagues had direct access to FIT.…”

Section: Methodsmentioning

confidence: 99%

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

et al. 2020

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Aim We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach. Method FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018. Results Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2–110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi‐square 167.1, P < 0.0001). FIT results ≥ 10.0 μg Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi‐square 73.6, P < 0.0001) and FIT results < 4.0 μg Hb/g faeces identified a group more likely to have non‐CRC pathology (5.1% vs 2.4%, chi‐square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 μg Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 μg Hb/g faeces had sensitivity 97.2% (85.5–99.9% CI), specificity 61.4% (58.1–64.7% CI), negative predictive value 99.8% (98.7–100.0% CI) and positive predictive value 9.5% (8.7–10.4% CI). Conclusion A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone.

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Straight‐to‐test colonoscopy for 2‐week‐wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high‐volume unit

Abstract: STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly.

Cited by 24 publications

References 14 publications

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

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