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Nigam GB, Meran L, Bhatnagar I, Evans S, Malik R, Cianci N, Pakpoor J, Manganis C, Shine B, James T, Nicholson BD, East JE, Palmer RM. FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation-a retrospective cohort study. Frontline Gastroenterol 2024; 15:190-197. [PMID: 38668989 PMCID: PMC11042356 DOI: 10.1136/flgastro-2023-102515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/02/2023] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
- Gaurav B Nigam
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Laween Meran
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ishita Bhatnagar
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sarah Evans
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Reem Malik
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Nicole Cianci
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Julia Pakpoor
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Charis Manganis
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rebecca M Palmer
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Isaic A, Motofelea AC, Costachescu D, Pop GN, Totolici B, Popovici D, Diaconescu RG. What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer? Healthcare (Basel) 2023; 11:2347. [PMID: 37628544 PMCID: PMC10454130 DOI: 10.3390/healthcare11162347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Rectal cancer is a significant healthcare burden, and effective treatment is crucial. This research aims to compare the effectiveness of surgical and endoscopic resection, transanal resection, and radiotherapy. METHODS A literature analysis was conducted in order to identify relevant studies, by comparing the different surgical approaches and variables affecting treatment decisions. The findings were analyzed and synthesized to provide a comprehensive overview. RESULTS Surgical treatment, particularly TME (total mesorectal excision), proved consistent efficacy in achieving complete tumor resection and improving long-term survival. Endoscopic treatment and transanal resection techniques were promising for early-stage tumors but were associated with higher local recurrence rates. Radiotherapy, especially in combination with chemotherapy, played a crucial role in locally advanced cases, improving local control and reducing recurrence risk. Patient data, tumor characteristics, and healthcare system factors were identified as important factors in treatment modality selection. CONCLUSION Surgical treatment, specifically TME, remains the recommended standard approach for rectal cancer, providing excellent oncological outcomes. Endoscopic treatment and transanal resection techniques can be considered for selected early-stage cases, while radiotherapy is beneficial for locally advanced tumors. Treatment decisions should be personalized based on patient and tumor characteristics, considering the available resources and expertise within the healthcare system.
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Affiliation(s)
- Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania;
- Department X of General Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Cătălin Motofelea
- Department of Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan Costachescu
- Department of Orthopedics-Traumatology, Urology, Radiology, and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Bogdan Totolici
- 1st Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
| | - Dorel Popovici
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Razvan Gheorghe Diaconescu
- OncoHelp Hospital, 300239 Timisoara, Romania;
- Department of Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
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Martins T, Ukoumunne OC, Lyratzopoulos G, Hamilton W, Abel G. Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study. Cancers (Basel) 2023; 15:3100. [PMID: 37370710 PMCID: PMC10296232 DOI: 10.3390/cancers15123100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated ethnic differences in the presenting features recorded in primary care before cancer diagnosis. METHODS English population-based cancer-registry-linked primary care data were analysed. We identified the coded features of six cancers (breast, lung, prostate, colorectal, oesophagogastric, and myeloma) in the year pre-diagnosis. Logistic regression models investigated ethnic differences in first-incident cancer features, adjusted for age, sex, smoking status, deprivation, and comorbidity. RESULTS Of 130,944 patients, 92% were White. In total, 188,487 incident features were recorded in the year pre-diagnosis, with 48% (89,531) as sole features. Compared with White patients, Asian and Black patients with breast, colorectal, and prostate cancer were more likely than White patients to have multiple features; the opposite was seen for the Black and Other ethnic groups with lung or prostate cancer. The proportion with relevant recorded features was broadly similar by ethnicity, with notable cancer-specific exceptions. Asian and Black patients were more likely to have low-risk features (e.g., cough, upper abdominal pain) recorded. Non-White patients were less likely to have alarm features. CONCLUSION The degree to which these differences reflect disease, patient or healthcare factors is unclear. Further research examining the predictive value of cancer features in ethnic minority groups and their association with cancer outcomes is needed.
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Affiliation(s)
- Tanimola Martins
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK;
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Willie Hamilton
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
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Holtedahl K, Borgquist L, Donker GA, Buntinx F, Weller D, Campbell C, Månsson J, Hammersley V, Braaten T, Parajuli R. Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care. BMC FAMILY PRACTICE 2021; 22:148. [PMID: 34238248 PMCID: PMC8268573 DOI: 10.1186/s12875-021-01452-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. METHOD Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher's exact test was used to analyse differences between groups. RESULTS Almost all symptoms recorded could indicate colorectal cancer. 'Rectal bleeding' had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had 'Rectal bleeding' at the initial consultation, but three of the 18 did so at a later consultation. 'Abdominal pain, lower part', 'Constipation' and 'Distended abdomen, bloating' were less specific and also less sensitive than 'Rectal bleeding', and with PPV between 0.7% and 1.9%. CONCLUSIONS Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.
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Affiliation(s)
- Knut Holtedahl
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Lars Borgquist
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Gé A. Donker
- Netherlands Institute of Health Services Research, Otterstraat 118, Utrecht, 3513 the Netherlands
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
- Maastricht University, P.O. Box 616, Maastricht, 6200 The Netherlands
| | - David Weller
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Box 100, 40530 Gothenburgh, Sweden
| | - Victoria Hammersley
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Tonje Braaten
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Ranjan Parajuli
- Faculty of Nursing and Health Sciences, Nord University, P.O.Box 1490, 8049 Bodø, Norway
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