Study makes an impression
A colorectal cancer diagnosis research project sponsored by GUTS is earning well-deserved recognition by publication in several medical journals. The study is authored by Will Maclean working alongside colleagues from the SE Bowel Cancer Screening Hub and the Royal Surrey NHS Trust.
The COVID-19 pandemic presented an unprecedented challenge for the healthcare system, dealing with a surge in hospitalizations generated by coronavirus. Across the NHS, elective surgery was postponed, outpatient appointments suspended and staff reassigned. In a rapid reprioritisation of care, surgical specialties proceeded with only selected operations, and surgery in COVID-19-positive patients generally avoided. For colorectal cancer (CRC), nonsurgical treatment was a workable alternative but for patients awaiting diagnosis, difficulties remained.
From mid-March 2020, routine access to colonoscopy became unavailable and faecal occult blood testing requests from the NHS colorectal screening pathway paused nationally. The two week wait pathway for fast-track referrals from primary care continued, although there was an initial fall in referral numbers. As a result, delays in cancer diagnoses downstream are bound to impact on patient outcomes and mortality. The Office for National Statistics has reported that excess mortality has increased by a factor greater than can be explained solely by those who had ‘coronavirus’ listed on their death certificate. Italy has already reported a drop in cancer diagnoses by 39% this year.
Faecal Immunochemical Testing (FIT) quantifies haemoglobin (blood) in faeces and is sensitive to the presence and severity of cancers. This study successfully enabled rapid testing for patients with symptoms, through the introduction of a small, portable FIT testing system. The kit can be used in GP surgeries and other clinical settings and provides results comparable in accuracy to the large machines that are used for routine screening. Those with CRC were successfully triaged to their investigations for timely diagnosis. This pathway followed both local and national guidance. The proportion of CRC diagnoses from all referrals did not statistically differ from pre-COVID-19 levels, despite colonoscopy rates being reduced by 28%, suggesting more effective use of this resource. There was a high take-up level, with 95% of patients who were asked to participate in the study providing samples.
The colorectal team at the Royal Surrey intend to continue using this system for all referrals as we have shown it to be an effective triage tool. It has reduced the overall number of patients requiring colonoscopy so those patients requiring further investigation after using the FIT test are prioritised.
Our congratulations to Will on the success of his project.