PTH-97 FIT in the post-COVID-19 colorectal pathway – are we doing it right?

IntroductionDuring COVID-19 pandemic, national guidance updated NG12 colorectal cancer (CRC) referral criteria to incorporate Faecal Immunochemical Testing (FIT), previously reserved only for patients on the low risk DG30 pathway. Positive FIT results (≥10μg/g of faeces) in patients with colorectal symptoms would trigger a two week wait (2ww) referral for urgent investigations. Otherwise, patients with ‘negative FIT’ were expected to be safety-netted but not investigated. Patients with high-risk symptoms (i.e. NG12 compliant) could be referred in the absence of FIT result. We wished to explore how this change has affected referral patterns and whether the new guidance was adhered to.MethodsWe extracted 2ww colorectal referrals to University College London Hospital from August to October 2020. Demographics, reason for referral, symptoms, investigations and outcome were recorded. These values were compared between patients who had FIT (FIT group) to those who did not (no FIT group). Two-tailed t-test and Chi-squared test were used to assess for significant difference between the two groups.Results522 referrals were received in the period examined, 92 were excluded as they were either repeat referrals or contained insufficient clinical information. Of the remaining 420, 315 underwent FIT, although 37% of results were negative. Of those with a positive FIT, 73% were NG12 compliant and 27% had neither NG12 nor DG30 symptoms. In the FIT negative group, 77% were NG12 compliant. 105 patients were referred without FIT, of these 90% were NG12 compliant. There was no significant difference in mean age (FIT 62 v no FIT 62 years, p = 0.10) and gender (p = 0.41). Although the differences did not reach significance, advanced pathology in the FIT group was much higher, both in polyps ≥10mm diameter (FIT 86% v no FIT 14%, p = 0.30) and CRC incidence (FIT 4.5% v no FIT 1.0%, p = 0.19).ConclusionsDespite the challenges of managing clinical services during a pandemic, our data demonstrates an increased use of FIT in the colorectal pathway in line with updated guidance. This is particularly encouraging as there was insufficient time for an adequate communication strategy. However, a substantial proportion of patients were referred based on FIT results with neither NG12 nor DG30 compliant symptoms;perhaps showing that FIT can potentially increase referrals if used incorrectly. Some patients were referred with a negative FIT and a preponderance of NG12 symptoms, possibly indicating that clinical concern over traditional cancer symptoms may prompt referral despite an objectively very low cancer risk.