Primary care faecal immunochemical testing (FIT) prioritisation of symptomatic patients could mitigate the effect of delays in the colorectal cancer (CRC) urgent diagnostic two-week-wait (2WW) pathway caused by the COVID-19 pandemic, according to a study published in Gut.
The study, led by the Institute of Cancer Research and Royal Marsden NHS Foundation Trust modelled the reduction in CRC survival and life years lost as a result of delays of two to six months in the 2WW pathway.
To construct the underlying models, the authors 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.
Delays of two, four and six months across all 11,266 patients diagnosed with CRC per typical year via the 2WW pathway were estimated to result in 653, 1419 and 2250 attributable deaths and loss of 9214, 20,315 and 32,799 life years.
Risk-benefit from urgent investigatory referral was sensitive to nosocomial COVID-19 rates for patients aged >60 years.
The model estimated that prioritisation out of delay for the 18 per cent of symptomatic referrals with FIT >10 µg Hb/g would avoid 89 per cent of deaths attributable to presentational/diagnostic delay while reducing immediate requirement for colonoscopy by >80 per cent.
The authors say 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, they say “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”.