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
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
复制标题
DOI：
10.1136/gutjnl-2020-321650
复制
发表时间：
2021-06-01
期刊：
影响因子：
24.5
通讯作者：
Turnbull, Clare
中科院分区：
文献类型：
--
作者：
Loveday, Chey;Sud, Amit;Turnbull, Clare
目的评估粪便免疫化学检测（FIT）优先化的影响，以减轻COVID-19大流行导致的结直肠癌（CRC）紧急诊断（2周等待（2 WW））途径延迟的影响。设计我们模拟了2 WW途径中每个患者延迟2-6个月导致的CRC生存率和生命年损失的减少。我们按年龄组分层，每个接受结肠镜检查的转诊患者的CRC生存率与年龄特异性院内COVID-19相关死亡率的个体水平获益。我们模拟缓解策略，使用阈值的FIT分诊2，10和150微克血红蛋白/克，优先2 WW转诊结肠镜检查。为了构建基础模型，我们采用了2008-2017年英格兰10年CRC净生存率，2 WW路径CRC病例和转诊量以及从诊断到治疗间隔的观察性研究产生的每日延迟HR。结果在所有11266例通过2 WW路径诊断的CRC患者中，每典型年延迟2/4/6个月，估计导致653/1419/2250例可归因死亡和9214/20315/32799生命年的损失。对于年龄>60岁的患者，紧急转诊的风险效益对医院COVID-19发病率特别敏感。对18%的FIT >10 μ g Hb/g的有症状转诊患者进行优先排除延误，可避免89%的因表现/诊断延误而导致的死亡，同时可将结肠镜检查的即时需求减少80%以上。结论CRC诊断和治疗途径的延误可能导致显著的死亡率和生命年损失。在初级保健中对有症状的患者进行FIT分诊可以简化结肠镜检查，减少真阳性CRC病例的延迟，并降低老年真阴性2 WW转诊患者的院内COVID-19死亡率。然而，这种策略仅在短期合理化有限的内镜服务方面提供了益处：有症状患者中FIT的明显假阴性率意味着大多数结肠镜检查仍将是必需的。
Objective To evaluate the impact of faecal immunochemical testing (FIT) prioritisation to mitigate the impact of delays in the colorectal cancer (CRC) urgent diagnostic (2-week-wait (2WW)) pathway consequent from the 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 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 mu g 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 HRs generated from observational studies of diagnosis-to-treatment interval.Results Delay of 2/4/6 months across all 11 266 patients with CRC diagnosed per typical year via the 2WW pathway were estimated to result in 653/1419/2250 attributable deaths and loss of 9214/20 315/32 799 life years. Risk-benefit from urgent investigatory referral is particularly sensitive to nosocomial COVID-19 rates for patients aged >60. Prioritisation out of delay for the 18% of symptomatic referrals with FIT >10 mu g Hb/g would avoid 89% of these deaths attributable to presentational/diagnostic delay while 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 of FIT in symptomatic patients means most colonoscopies will still be required.