The use of Faecal Immunochemical Testing (FIT) and Minimal Preparation Computed Tomography (MPCT) during COVID-19 for Urgent Suspected Cancer (USC) referrals in patients with lower gastro-intestinal symptoms

Introduction: Revised patient pathways incorporating combinations of FIT and MPCT were introduced to triage USC referrals during the COVID-19 pandemic to replace straight-to- test colonoscopy. This study aims to evaluate the effectiveness of a secondary care diagnostic pathway improvement initiative for colorectal cancer referrals. Method: All consecutive patients referred from primary care on the USC pathway between 15th March -15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations, timelines and patient outcomes up to 90 days following initial referral. Results: 816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 -97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to- face consultations during this first wave of the pandemic. Referred patients required a median of 1 secondary care investigation (0 -6). Overall, 5.6% of USC referrals were diagnosed with CRC, similar to pre-pandemic rates. Median timescale from diagnosis to treatment for CRC was 82 (4 -175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%. Conclusion: A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.