Measures to Increase the Effectiveness of Fast Track Colorectal Clinics for Iron Deficiency Anaemia.

Study Overview
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Brief Summary
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A retrospective cohort study was conducted from 2016-18 in a single busy district general hospital providing services to a population of 700,000 people. In the study, patients with true IDA (low MCV and ferritin) were found to be more likely to have Colorectal cancer compared to any other type of anaemia which confirmed the latest guidelines for management of IDA. Compared to symptoms, only the presence of a mass on abdominal examination and rectal examination was found to be more likely associated with cancer.

Detailed Description
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Although there are strict and specific guidelines for referring patients with iron deficiency anaemia (IDA) to fast track colorectal cancer (FT CRC) clinics for further assessment and investigation, patients with other types of anaemia are still referred by primary care physicians in the UK. Investigators aim was to find out whether this practice is correct, or if it is causing an overburden on colorectal clinics and endoscopy services. Investigators also want to find out whether true/absolute IDA has a higher predictive value for diagnosing colorectal cancer (CRC) compared to other types of anaemia and specific bowel symptoms. Investigator's hypothesis was that patients with IDA are more likely to have CRC compared to patients with no anaemia or non-IDA anaemia. By confirming this hypothesis, Investigators can identify high risk patients from the population who can then be preferentially subjected to investigations mandated by guidelines. This strategy can help to increase the diagnostic yield of FT CRC clinics. A retrospective cohort study was conducted from 2016-18 in a single busy district general hospital providing services to a population of 700,000 people. In the study, patients with true IDA (low MCV and ferritin) were found to be more likely to have CRC compared to any other type of anaemia which confirmed the latest guidelines for management of IDA. Compared to symptoms, only the presence of a mass on abdominal examination and rectal examination was found to be more likely associated with cancer. Physicians should be able to stratify patients based on blood indices when referring them to FT CRC clinics. Diagnostic yield of these clinics can be increased if clinicians strictly adhere to fast track guidelines and confirm true IDA before referring patients to clinic.

Official Title
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Establishing Absolute Iron Deficiency Anaemia Before Referring Patients to Colorectal Fast Track Clinics Can Help to Increase the Diagnostic Yield of the Bowel Cancer Screening Programme.

Conditions
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Colorectal Cancer

Intervention / Treatment
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* Diagnostic Test: Colonoscopy, gastroscopy, virtual colonoscopy, CT scan


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Patients with age more than 18 years Presenting to fast track colorectal clinic With bowel symptoms Presenting with anaemia Rectal bleeding Exclusion Criteria: Any patient presenting through routine colorectal clinics With bowel symptoms Presenting with anaemia Rectal bleeding Aged less than 18 years

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Iron deficiency anaemia with bowel symptoms<br>Patients with IDA presenting with bowel symptoms like change in bowel habits, weight loss and abdominal mass other than rectal bleed | Diagnostic Test: Colonoscopy, gastroscopy, virtual colonoscopy, CT scan<br>* Patients referred with a suspected bowel malignancy were subjected to top and bottom endoscopic examination or a cross sectional imaging like CT scan and MRI scan.<br>|
| Iron deficiency anaemia with no bowel symptoms<br>Patients with IDA with no bowel symptoms | Diagnostic Test: Colonoscopy, gastroscopy, virtual colonoscopy, CT scan<br>* Patients referred with a suspected bowel malignancy were subjected to top and bottom endoscopic examination or a cross sectional imaging like CT scan and MRI scan.<br>|
| Iron deficiency anaemia with rectal bleeding<br>Patients with IDA and rectal bleeding | Diagnostic Test: Colonoscopy, gastroscopy, virtual colonoscopy, CT scan<br>* Patients referred with a suspected bowel malignancy were subjected to top and bottom endoscopic examination or a cross sectional imaging like CT scan and MRI scan.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic yield of colorectal cancer | diagnostic yield of colorectal cancer in patients presenting to fast track clinics with symptomatic ,asymptomatic anaemia, anaemia with normal blood indices, anaemia with Iron deficiency anaemia and certain bowel symptoms was measured. Patients were subjected to endoscopy for diagnosis. Diagnostic yield was expressed as diagnostic odds ratio and measured by statistical tools like Mantel Haenszel trend test and results are illustrated in the from of odds ratio. Crude odds ratio could not be used as association of binary outcome (colorectal caner or no cancer) with binary predictors in multiple case control groups was assessed. | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anaemia, colorectal cancer, Iron deficiency anaemia