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The utilisation of CT colonography in patients
symptomatic for colorectal cancer
Background
The capacity challenge:
Colorectal cancer is the third most common cancer in the UK and the
second most common cause of cancer death in the UK
CRC has an annual incidence of approximately 40,000 new cases
Within Guy’s and St Thomas’ NHS Foundation Trust, colon cancer is one
of the two most difficult areas in terms of delivering cancer targets
Less than 10% of patients referred to NHS outpatient clinics on
suspicion of CRC are actually diagnosed with the disease
New NICE guidelines published in June 2015 have broadened the
inclusion criteria for urgent cancer referrals for patients who are
symptomatic for colon cancer.
Increasing demand for optical colonoscopy is placing a considerable
pressure on workload for secondary care
This means an increased number of urgent ‘2 Week Wait’ referrals to
the Trust.
STUDY AIM: The TOHETI study aims to assess whether a change in the current diagnostic pathway, replacing optical
colonoscopy with CT colonography as the first-line test for symptomatic patients, will increase early detection of colon
cancer, improve outcomes and have cost-saving benefits.
The Study pathway:
Study details
The study will take place in the Colorectal
and Gastroenterology Units at Guy’s and St
Thomas’ NHS Foundation Trust.
Patients taking part in the study will
undergo either a CT Colonography or an
Optical Colonoscopy examination, as per
Guy’s and St. Thomas’ current standard of
care.
Referral to Optical Colonoscopy will be the
first imaging test as per GSTT’s standard of
care during Phase 1
Referral to CT Colonography will be the first
imaging test as per GSTT’s standard of care
during Phase 2
The study aims to recruit 246 patients in
total (123 patients in each group).
Target group is patients referred for change
in bowel habit requiring large bowel
investigation
Improvements to the bowel prep service
have also been introduced, following
patient feedback on their experience.
Outcomes
Patient experience
and satisfaction
Expected impact
Increased patient experience for patients
undergoing the CT colonography-based pathway
Quality of care
Increased quality of life associated with the
proposed pathway
Shift of optical colonoscopy capacity to diagnose
high risk CRC patients
Cost-effectiveness
Decreased overall cost per patient
Increased cost-effectiveness in the management
of symptomatic CRC patients
CONTACT US: Project Manager: Ms Bharti Malhotra
“It is well established in the literature that CT colonography
has an equivalent diagnostic accuracy to optical colonoscopy
in the detection of medium sized polyps and cancers in the
large bowel.
At present it is an under-utilitised resource in our trust. This
study will offer improved access to CT colonography as a noninvasive first line test for patients with large bowel symptoms.
The outcome of this study will then help facilitate discussions
on a revised Colon Cancer pathway in our trust, which should
be more cost effective, with improved patient experience, and
reduced waiting times.”
Nyree Griffin, Consultant Radiologist, Gastrointestinal
Imaging; Chief Investigator, TOHETI Colon study
Ext. 89578
[email protected]