Implementation of a risk mitigating COVID-adapted colorectal cancer pathway.

COVID-19 has brought about unprecedented challenges to healthcare systems forcing them to meet the sudden increase in demand of large numbers of critically ill patients. However, the long-term negative impact will be on patients without COVID due to lost opportunities to undergo standard diagnostic testing and treatment in a timely manner.1 We introduced a COVID-adapted colorectal cancer pathway at the outset of the pandemic in an attempt to mitigate the risks of delayed and missed cancer diagnoses. The COVID-adapted pathway design was based on appraisal of the current literature and used the available non-aerosol generating testing tools, namely, quantitative faecal immunochemistry testing (qFIT) and CT scanning with oral preparation (figure 1)2–4 and triaged patients based on their symptomatic risk (high-risk symptoms, including palpable abdominal mass, persistent change in bowel habit to looser stool not just simple constipation, repeated rectal bleeding without an obvious benign anal cause or blood mixed in with the stool, abdominal pain with weight loss with or without iron deficiency anaemia). The qFIT test is routinely used for screening and as a triage tool in low-risk populations, however it is not used as a rule out test in those with potential colorectal cancer due to its sensitivity. The threshold of 10 µg/g was not used for investigation as data from several health boards suggest that the positivity rate is ~23%. We, therefore, used the threshold of 80 µg/g as based on the Scottish bowel screening guidelines. Figure 1 A summary of the COVID-adapted colorectal pathway. Patients were triaged by colorectal consultants with information provided from general practice. They proceeded through the pathway in a …