FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation–a retrospective cohort study
Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer
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引用次数: 0
Abstract
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway. Data are available upon reasonable request.
FIT 阴性门诊作为低风险结直肠癌患者的安全网:对内镜检查和放射科利用率的影响--一项回顾性队列研究
背景 国家健康与护理优化研究所(National Institute for Health and Care Excellence)建议使用粪便免疫化学检验(FIT)对有不明症状但不符合疑似下消化道癌症路径标准的无症状初级保健患者进行分流。在 COVID-19 大流行期间,FIT 被用于对紧急转诊的 2 周等待(2ww)癌症患者进行分流,而不是采用直接检测策略。对 FIT 阴性患者进行评估,并在 FIT 阴性诊所进行安全防护。方法 我们回顾了一家三甲医院在 2020 年 6 月至 2021 年 4 月期间通过 2 周等待途径转诊并在 FIT 阴性门诊就诊的 622 名患者的病例记录。我们收集了有关人口统计学、转诊指征、转诊日期、门诊就诊、检查和长期结果的信息。结果 患者平均年龄为 71.5 岁,54% 为女性,中位随访时间为 2.5 年。转诊原因包括:贫血(11%)、缺铁(24%)、体重减轻(9%)、直肠出血(5%)和排便习惯改变(61%)。在这些病例中,28%(95% CI 24% 至 31%)在门诊复查后要求进行内窥镜检查(15%,95% CI 12% 至 18%)和/或放射学检查(20%,95% CI 17% 至 23%),其中恶性肿瘤的发生率为 1.7%,包括直肠乙状结肠神经内分泌肿瘤、食道癌和肺腺癌。结论 FIT 阴性诊所为症状不明但罹患结直肠癌风险较低的患者提供了一个安全网。这些实际数据表明,通过 2ww 途径转诊的 FIT 阴性患者对内镜检查和放射科服务的需求明显减少。如有合理要求,可提供相关数据。
期刊介绍:
Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.