28th August 2020

Bowel cancer diagnosis pathways and the impact of the COVID-19 pandemic

Research led by the Institute of Cancer Research, involving DATA-CAN, has highlighted the significantly negative impact that the COVID-19 pandemic has had on the diagnostic pathway for bowel cancer.

Bowel cancer (also known as colorectal cancer) is the fourth most common cancer in the UK and the 2nd most common cause of cancer death. If it is diagnosed early, nearly everyone with bowel cancer can be successfully treated. However, survival drops significantly as the disease develops. Early diagnosis really does help save lives.

Research led by the Institute of Cancer Research, involving researchers from DATA-CAN: The Health Data Research Hub for Cancer, has highlighted the significantly negative impact that the COVID-19 pandemic has had on the diagnostic pathway for bowel cancer. The research, published in the journal Gut, looked at the effect of the pandemic using data from the 2 week wait (2WW) urgent diagnostic pathway for bowel cancer. It modelled different scenarios of delays of between two and six months in referring and diagnosing patients with the disease.

The modelling found that there was a significant risk of reducing 10 year survival of patients. There could be between 650 and 2,250 potential additional deaths in England depending on the length of the delay (2 – 6 months) in referring and diagnosing patients.

The research looked at the use of Faecal Immunochemical Testing (FIT) (a non-invasive test that detects small quantities of blood in a stool sample and can be used for screening) in patients with bowel symptoms. It showed that this approach could be used to help select which patients who should be prioritised for colonoscopy, one of the principal diagnostic tools for bowel cancer. This is particularly important when colonoscopy services are significantly reduced, as they were during the pandemic lockdown.

Using this ‘FIT triage’ approach to help prioritise patients could help decrease this excess risk of death significantly and reduce the need for colonoscopy whilst these services are compromised during the COVID-19 pandemic. However, this approach should only be considered as a short term option until normal colonoscopy services are resumed.

Prof Mark Lawler, Queen’s University Belfast, Scientific Lead of DATA-CAN, the UK’s Health Data Research Hub for Cancer and a co-author on the paper said,

“This research, published in one of the world’s premier gastroenterology journals, emphasises how the pandemic is having a significant negative impact on common cancers such as bowel cancer, which currently kills over 16,000 people in the UK. Using data and informed intelligence to underpin our response to the pandemic is the only way to ensure that we adequately protect our patients from the risks associated with presentational and diagnostic delay due to the COVID-19 pandemic.”

Read the research article in Gut here – 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.