Short-term outcomes of a COVID-adapted triage pathway for colorectal cancer detection.

AIM: The dramatic curtailment of endoscopy and CT colonography capacity during the coronavirus pandemic has adversely impacted timely diagnosis of colorectal cancer (CRC). We describe a rapidly implemented COVID-adapted diagnostic pathway to mitigate risk and maximize cancer diagnosis in patients referred with symptoms of suspected CRC. METHOD: The 'COVID-adapted pathway' integrated multiple quantitative faecal immunochemical tests (qFIT) to enrich for significant colorectal disease with judicious use of CT with oral contrast to detect gross pathology. Patients reporting 'high-risk' symptoms were triaged to qFIT+CT and the remainder underwent an initial qFIT to inform subsequent investigation. Demographic and clinical data were prospectively collected. Outcomes comprised cancer detection frequency. RESULTS: Overall, 422 patients (median age 64 years, 220 women) were triaged using this pathway. Most (84.6%) were referred as 'urgent suspicious of cancer'. Of the 422 patients, 202 (47.9%) were triaged to CT and qFIT, 211 (50.0%) to qFIT only, eight (1.9%) to outpatient clinic and one to colonoscopy. Fifteen (3.6%) declined investigation and seven (1.7%) were deemed unfit. We detected 13 cancers (3.1%), similar to the mean cancer detection rate from all referrals in 2017-2019 (3.3%). Compared with the period 1 April-31 May in 2017-2019, we observed a 43% reduction in all primary care referrals (1071 referrals expected reducing to 609). CONCLUSION: This COVID-adapted pathway mitigated the adverse effects on diagnostic capacity and detected cancer at the expected rate within those referred. However, the overall reduction in the number of referrals was substantial. The described risk-mitigating measures could be a useful adjunct whilst standard diagnostic services remain constrained due to the ongoing pandemic.

Nurse-led telephone outreach for a COVID-adapted suspected colorectal cancer pathway

Background: COVID-19 has brought about unprecedented challenges to healthcare services in the UK. The pandemic led to the cessation of colonoscopy and outpatient clinics. A bespoke COVID-adapted cancer pathway, using computed tomography (CT) scanning and the quantitative faecal immunochemical test (qFIT), was introduced to mitigate the risks of patients referred with potential colorectal cancer. Aims: This study aims to evaluate the workload of patient telephone calls undertaken by nurses and their impact on the operation of the pathway. Methods: Data were collected prospectively and analysed to assess the volume of patient flow, number of calls made and content of conversations. Findings: During a 2-month period, 975 patients (56.6% female, median age 63 years) were registered on the COVID-adapted cancer pathway. The 45.9% (n=448) of patients who did not return qFIT tests in a timely manner were contacted. Of these, 9.4% (n=42) requested to postpone or declined an appointment. Most were appreciative of the opportunity to clarify the rationale of the pathway and address any concerns. Conclusions: Phone calls made and received by nursing staff were helpful to discuss patient concerns and increase patients' understanding of the alternative treatment options available during the pandemic.