The Use of the Faecal Immunochemical Test during the Covid-19 Pandemic to Triage Urgent Colorectal Cancer Referrals

ABSTRACT

Aim: During the first wave of the Covid19 pandemic in 2020, elective GI endoscopy services were abbreviated for fear of viral transmission. However, primary care continued to refer patients on the NG12 pathway. Serendipitously, a national study suggested that a new Faecal Immunochemical Test might be helpful in triaging patients with colorectal alarm symptoms. Method(s) A single centre observational study of patients referred using NG12 referral criteria between March and August [pb1] 2020. Patients were triaged to the urgent cancer pathway if FIT >= 10 mg/ml and investigated using latest NHS England guidance. Demographic data, method of investigations, cancer and polyp detection rates were compared to those observed in a cohort of patients who had been referred in the previous six months prior when FIT was not used as the triage tool (September 2019 to February 2020) when Covid 19 was not prevalent. Result(s) A total of 1192 patients with a median age of 70 years (IQ range 58-79) of which 53.9% were male, were referred using NG12 guidelines during the pandemic period compared with 1592 patients with a median age of 72 years (IQ range 59.5-91) of which 49.2% were male, in the prior six months. Colorectal cancer was detected in 45 patients, (3.2%) compared with 38 patients (2.8%) in the pre pandemic period (NS). There were two patients who turned out to have CRC despite a negative FIT. After the introduction of FIT as a triage tool, there was a significant reduction in the use of endoscopy (n = 463, 42.3% vs. n = 1186, 74.5%, P = 0.035) with a significant increase in CT scanning (n = 677, 61.2% vs. n = 750, 47.1%, P = 0.035). Conclusion(s) The use of FIT in NG12 patients triaged during the first wave of the Covid 19 pandemic reduced endoscopy but not CT scanning and did not compromise CRC detection rates. The use of FIT triage for endoscopic investigation is a safe method that aids in reducing the burden on services greatly. A negative FIT test does not absolutely exclude CRC.