ABSTRACT
Background: COVID-19 required restructuring of colorectal cancer (CRC) diagnostics. We instituted consultant telephone assessment of all urgent suspected cancer (USC) referrals. CT abdomen and pelvis (CTAP) and Faecal Immunochemical Testing (FIT) were the primary modalities of investigation in patients without rectal bleeding or anaemia. We report on efficacy and safety at 15 months follow up. Method(s): 277 USC CRC referrals were received between 1st April and 30th May 2020. Patients with rectal bleeding (n = 41) were directed to sigmoidoscopy. Consultant surgeons telephoned 236 non-bleeding patients of whom 196 were referred for FIT and CTAP, whilst 40 patients were downgraded from USC. 182 CTAP scans and 136 FIT tests were performed. Not all patients had both tests as positive CT findings prompted endoscopy referral and some patients declined further investigation. Result(s): Over two months, 16 diagnoses of CRC were made;15 from the CTAP/FIT group and one from flexible sigmoidoscopy (detection rate 5.8%). This compares to 524 USC referrals and 19 CRC diagnoses (detection rate 3.6%) over the equivalent period in 2019. Follow up at 15 months showed that no patient discharged from the USC pathway had re-presented with colorectal cancer. Conclusion(s): Combining FIT and CTAP in the USC setting draws on the developing use of FIT in CRC investigation. This was initially a pragmatic response to COVID-19, however our experience of using this pathway for exclusion of CRC will be relevant to maintenance and streamlining of USC services after the pandemic.