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Abstract
Objective:To evaluate the impact of faecal immunochemical testing (FIT) prioritisation to mitigate the impact of delay in the 2-week-wait (2WW) colorectal cancer (CRC) urgent diagnostic pathway consequent from the Coronavirus disease 2019 (COVID-19) pandemic.Design:We modelled the reduction in CRC survival and life years lost resultant from per-patient delays of 2-6 months in the 2WW pathway. We stratified by age-group, individual-level benefit in CRC cancer survival versus age-specific nosocomial COVID-19-related fatality per referred patient undergoing colonoscopy. We modelled mitigation strategies using thresholds of FIT triage of 2, 10 and 150 ug Hb/g to prioritise 2WW referrals for colonoscopy. To construct the underlying models, we employed 10-year net CRC survival for England 2008-2017, 2WW pathway CRC case and referral volumes and per-day-delay hazard ratios generated from observational studies of diagnosis-to-treatment interval.Results:Delay of 2/ 4/ 6 months across all 11,266 CRC patients diagnosed per typical year via the 2WW pathway were estimated to result in 653/ 1,419/ 2,250 attributable deaths and loss of 9,214/ 20,315/ 32,799 life years. Risk-benefit from urgent investigatory referral is particularly sensitive to nosocomial COVID-19 infection rates for patients aged >60. Prioritisation out of delay for the 18% of symptomatic referrals with FIT >10 ug Hb/g would avoid 89% of these deaths attributable to delay, whilst reducing immediate requirement for colonoscopy by >80%.Conclusions:Delays in the pathway to CRC diagnosis and treatment have potential to cause significant mortality and loss of life years. FIT-triage of symptomatic patients in primary care could streamline access to colonoscopy, reduce delays for true-positive CRC cases and reduce nosocomial COVID-19 mortality in older true-negative 2WW referrals. However, this strategy offers benefit only in short-term rationalisation of limited endoscopy services: the appreciable false-negative rate in symptomatic patients of FIT means colonoscopy is still required in the majority.
Original language | English |
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Publication status | Published - 17 Nov 2020 |
Event | Joint Public Health Conference 2020: Picking up the Pieces - Public Health and COVID-19 - Duration: 17 Nov 2020 → 17 Nov 2020 https://publichealth.ie/joint-public-health-annual-conference/ |
Conference
Conference | Joint Public Health Conference 2020 |
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Period | 17/11/2020 → 17/11/2020 |
Internet address |
Keywords
- COVID-19
- faecal immunochemical test
- Cancer
- Colorectal cancer
- Colonoscopy
- Waiting Lists
- Waiting times
- Capacity planning
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Dive into the research topics of 'Prioritisation by FIT to mitigate the impact of delays in the 2-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study'. Together they form a unique fingerprint.Activities
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Next steps for cancer care in Northern Ireland
McFerran, E. (Advisor)
09 Feb 2024Activity: Talk or presentation types › Invited talk
Research output
- 1 Article
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Prioritisation by FIT to mitigate the impact of delays in the two-week wait colorectal cancer referral pathway during the COVID-19 pandemic: a UK modelling study
Sud, A., Jones, M., Broggio, J., Scott, S., Loveday, C., Torr, B., Garrett, A., Nicol, D. L., Jhanji, S., Boyce, S. A., Williams, M., Lyratzopoulos, G., Barry, C., Riboli, E., Kipps, E., McFerran, E., Lawler, M., Muller, D. C., Abulafi, M. & Houlston, R. & 1 others, , 27 Aug 2020, (Early online date) In: Gut.Research output: Contribution to journal › Article › peer-review
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