ABSTRACT
Purpose/Background: To investigate the effectiveness of a one-stop colorectal cancer (CRC) staging pathway using faecal immunochemical test (FIT) as stratification tool. Methods/Interventions: The OSCARS pathway, which uses FIT as a triage tool to identify 'high risk' patients, was formally introduced in March 2020 in our Hospital Trust. A major driving force for this was to deal with the increased pressures on diagnostic services resulting from the COVID-19 pandemic. 2 week wait colorectal cancer referrals deemed appropriate to proceed to diagnostic testing prior to a clinic review ('straight to test') who had a FIT > 100 μg Hb/g faeces were allocated to the OSCARS pathway. This involved a single hospital visit during which they would have an endoscopy, a staging CT or completion CT colonography if needed, and be assessed and counseled by a colorectal cancer surgeon. Notes of all patents referred with suspected colorectal cancer between 01/01/2020 and 16/03/2021 (prior to the introduction of the pathway) and 16/03/2021 and 31/07/2021 (post introduction of the pathway) were reviewed to evaluate outcomes of the pathway. Time from referral to investigations, histological diagnosis and discussion at multidisciplinary team (MDT) meeting was compared before and after the introduction of the OSCARS pathway. Results/Outcomes: There were a total of 748 patients referred with suspected colorectal cancer in the pre-OSCARS group and 1194 in the OSCARS group. of those who were referred with an increased FIT, 43 (8.0%) and 86 (7.9%) were diagnosed with colorectal cancer (CRC) respectively. CRC diagnoses established on a 'straight to test' pathway increased from 69.8% in pre-OSCARS to 86.0% in the OSCARS groups, likely due to better stratification to a 'straight to test' pathway through the use of FIT. Despite the COVID-19 pandemic coinciding with the introduction of the OSCARS pathway, time for 'referral to first investigation' and 'referral to endoscopy' were similar between the groups (13 vs 12 days, p = 0.511 and 13 vs 13, p = 0.988). All patients diagnosed with cancer in the OSCARS group had staging CT scan on the same day (as opposed to 4 days pre-OSCARS, p = 0.002) but the difference in time for 'endoscopy to MRI' (8 vs 5 days, p0.271) or 'endoscopy to histopathology (4 vs 5 days, p = 0.236) did not change significantly. Time for 'endoscopy to MDT' was significantly reduced from 14.5 to 9 days (p = 0.019). Conclusion/Discussion: Time from referral to diagnostic test on 'straight to test' pathway remained unchanged in our Trust despite COVID-19 pandemic as a result of stringent stratification using FIT. Time from 'endoscopy to MDT' was significantly reduced with introduction of the OSCARS pathway due to same day access to CT scanner. It is likely that this section of the 2ww pathway would further be reduced with improved access to MRI and histopathology reporting services. Although OSCARS pathway reduces the number of hospital visits, its effect on patients' experience needs to be formally assessed.
ABSTRACT
PURPOSE: Globally planned surgical procedures have been deferred during the current COVID-19 pandemic. The study aimed to report the outcomes of planned urgent and cancer cases during the current pandemic using a multi-disciplinary prioritisation group. METHODS: A prospective cohort study of patients having urgent or cancer surgery at a NHS Trust from 1st March to 30th April 2020 who had been prioritised by a multi-disciplinary COVID Surgery group. Rates of post-operative PCR positive and suspected COVID-19 infections within 30 days, 30-day mortality and any death related to COVID-19 are reported. RESULTS: Overall 597 patients underwent surgery with a median age of 65 years (interquartile range (IQR) 54-74 years). Of these, 86.1% (514/597) had a current cancer diagnosis. During the period, 60.8% (363/597) of patients had surgery at the NHS Trust whilst 39.2% (234/597) had surgery at Independent Sector hospitals. The incidence of COVID-19 in the East Midlands was 193.7 per 100,000 population during the study period. In the 30 days following surgery, 1.3% (8/597) of patients tested positive for COVID-19 with all cases at the NHS site. Overall 30-day mortality was 0.7% (4/597). Following a PCR positive COVID-19 diagnosis, mortality was 25.0% (2/8). Including both PCR positive and suspected cases, 3.0% (18/597) developed COVID-19 infection with 1.3% at the independent site compared to 4.1% at the NHS Trust (p=0.047). CONCLUSIONS: Rates of COVID-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.