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2.
Br J Cancer ; 124(7): 1231-1236, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065853

ABSTRACT

BACKGROUND: The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence. METHODS: All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 µg Hb/g faeces defined a positive test. RESULTS: Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1-9.3%). Negative predictive value was 99.8% (CI 99.5-99.9%). Sensitivity was 84.3% (CI 71.4-93.0%), specificity 85.0% (CI 83.8-86.1%). The area under the ROC curve was 0.92 (CI 0.86-0.96). A threshold of 37 µg Hb/g faeces would identify patients with an individual 3% risk of cancer. CONCLUSIONS: FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.


Subject(s)
Colorectal Neoplasms/diagnosis , Feces/chemistry , Occult Blood , Primary Health Care , Anemia, Iron-Deficiency/complications , Colorectal Neoplasms/complications , Colorectal Neoplasms/physiopathology , England , Female , Hemoglobins/analysis , Humans , Male , Middle Aged , Risk Factors , Sensitivity and Specificity , Weight Loss
4.
Dig Liver Dis ; 52(7): 695-699, 2020 07.
Article in English | MEDLINE | ID: covidwho-277040

ABSTRACT

We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.


Subject(s)
Colorectal Neoplasms , Coronavirus Infections , Endoscopy, Gastrointestinal , Fear , No-Show Patients , Pandemics , Pneumonia, Viral , Stomach Neoplasms , Attitude to Health , Betacoronavirus/isolation & purification , COVID-19 , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/physiopathology , Colorectal Neoplasms/psychology , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/transmission , Disease Outbreaks , Endoscopy, Gastrointestinal/psychology , Endoscopy, Gastrointestinal/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Middle Aged , No-Show Patients/psychology , No-Show Patients/statistics & numerical data , Outcome Assessment, Health Care , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/transmission , SARS-CoV-2 , Stomach Neoplasms/diagnosis , Stomach Neoplasms/epidemiology , Stomach Neoplasms/physiopathology , Stomach Neoplasms/psychology , Surveys and Questionnaires
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