2-week Pathway Research Articles

Faecal immunochemical testing reduces demand and improves yield of Leicester's 2-week pathway for change in bowel habit.

We look at the effect of introducing the faecal immunochemical test (FIT) in the straight-to-test 2-week pathway for change in bowel habit (CIBH). The FIT in primary care triages 2-week wait (2WW) colorectal referrals for patients aged 60 years and above for straight-to-test CT colonography (CTC). We compare the impact of the FIT on numbers of 2WW CTCs, in the year before and after FIT, in both colorectal cancer (CRC) detection and cost-effectiveness at both 4 μg Hb/g faeces and 10 μg Hb/g faeces. At a threshold of 4μg Hb/g faeces, the positive predictive value of the FIT for diagnosis of CRC is 5.0% with a negative predictive value of 99.8% and a polyp detection rate of 25.5%. The introduction of the FIT resulted in a reduction in the number of CTCs performed through the CIBH pathway from a mean of 143.9 per month prior to the FIT to 66.8 CTCs per month once the FIT was well established. Given a FIT threshold of 10μg Hb/g the number of CTCs would be predicted to fall by 70.4% to 42.6 CTCs per month resulting in higher CRC and polyp detection rate, and an estimated annual cost saving of £238 258 in our institution. The FIT use in primary care improves the yield of 2WW referrals for CIBH alone and reduces the burden and cost of investigations to exclude CRC. Improvements may be possible by increasing the cut-off employed, without adversely affecting the risk of missing a cancer.

Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms.

To determine the efficacy of a new 2-week wait pathway that uses the faecal immunochemical test (FIT) in primary care to triage patients with high and low risk symptoms suspicious of colorectal cancer (CRC). This service improvement pilot follows 2017 National Institute for Health and Care Excellence guidance, that recommended using FIT to guide referral of patients with low risk, but not high risk symptoms, which continue to be referrred on the 2-week pathway. Patients with high- and low-risk CRC symptoms were tested with FIT and those with faecal haemoglobin (f-Hb) ≥9.5μg haemoglobin/g faeces (hereafter μg/g) were referred to secondary care. Results were tracked and primary care prompted to refer if timely referral was not made. Between December 2019 and October 2020, 5672 patients presented to primary care with high and/or low risk symptoms warranting investigations. Of these, 622 (11%) patients were referred without a FIT, of whom 36 (5.8%) had CRC. The remaining 5050 patients had a FIT, of which 4187 (83%) were processed to produce a quantitative result. Of these, 1085 patients (25.9%) had an f-Hb ≥9.5μg/g and of those, 982 patients (90.5%) were referred and 56 (5.7%) had CRC. A total of 3102 patients (74.1%) had an f-Hb <9.5μg/g, of which 456 (14.7%) were referred and three (0.7%) had CRC. A total of 97 cancers were diagnosed with a cancer prevalence of 1.7%. A 2-week wait pathway incorporating FIT as a triage tool can be implemented successfully in primary care to identify symptomatic patients at highest risk of CRC.

TU4.4 ‘Nurse led Colorectal 2ww clinic’: Impact on early assessment and faster diagnosis of colorectal cancer

Abstract Background Colorectal cancer (CRC) is the second most common cancer death in the UK with a 5-year relative survival rate is 57%, which has improved over the last 30 years. Early detection of the cancer has a great impact on its prognosis. In our large district general hospital, we receive GP 2 week pathway referrals for suspected CRC with an average monthly referral of 726. Therefore, the aim of this study is to assess if recently introduced nurses led colorectal rapid access clinic has any impact on early assessment that can facilitate faster diagnosis. Method A retrospective analysis of a prospectively collected data of the patient referred through a 2-week colorectal clinic pathway from outpatient referral system, was carried out from April, 2021 to November, 2021. Patient feedback and clinician advice and guidance were also evaluated in the same period. Result A total of 900 patients were reviewed in our Nurse led clinic with CRC detection rate of 2% approximately. Final diagnosis of cancer been made within the 28th day. Increment of 21% was seen in referrals per month. Optimal slots of 195/week are required but the nurse led clinic capacity is only 40/week. Despite the increased referral, patients are being provided with results within day 13 with positive feedback from the patients. Conclusion Despite of overwhelmed referrals, final diagnosis is provided within 28 days. Nurse Led Colo-rectal Clinic could be the answer to relieving the capacity, financial pressures and providing high quality safe patient care for our already strained NHS.

Characteristics and outcomes of patients with suspected heart failure referred in line with National Institute for Health and Care Excellence guidance

ObjectiveTo describe the population, heart failure (HF) diagnosis rate, and 1-year hospitalisation and mortality of patients with suspected HF and elevated N-terminal pro B-type natriuretic peptide (NTproBNP) investigated according to...

Presentation of childhood cancers to a paediatric shared care unit

ObjectiveTo describe the pathways by which children with cancer present to a shared care oncology unit.DesignA population-based retrospective cohort study of children diagnosed with cancer between the years 2004 and...

PTH-010 Comparison of colorectal cancer diagnoses in bowel cancer screening and 2-week rule patients: Abstract PTH-010

Introduction The two most common pathways through which colorectal cancer (CRC) is diagnosed in 60–69-year-olds are the 2-week wait pathway or bowel cancer screenng. The 2-week wait system involves fast tracking patients with worrying symptoms such as rectal bleeding, change of bowel habit to loose stools or iron deficiency anaemia to colonoscopy. Bowel cancer screening patients are offered faecal occult blood (FOB) testing and then colonoscopy if they prove positive. We have compared the CRC diagnoses made via each pathway. Methods We identified all 60–69-year-olds who underwent colonoscopy between 1.4.08 and 31.3.09 in the Newcastle Hospitals as part of the Bowel Cancer Screening Programme or via the 2-week wait system from the endoscopy IT system. All patients with a colonoscopic diagnosis of CRC or of a polyp had their histology reviewed. All patients with confirmed CRC, after multidisciplinary team review and treatment were categorised as to the site and staging of the cancer and the two groups were compared. Results See Abstract 010. Conclusion Patients with bowel cancer diagnosed by bowel cancer screening are more likely to have their CRC in the sigmoid colon and to be diagnosed at an earlier stage than those referred through the 2-week pathway. There is a strong trend towards patients being diagnosed by BCS being male.