Introduction The Direct to Test (DTT) system has recently been instigated to investigate suspected colorectal cancer. Patients are allocated a DTT endoscopy or an initial traditional outpatient appointment. The aim of this novel study was to detect the yield results of the DTT cohort compared to the outpatient (OPA) group, establish benefits and ascertain if this modern practice is acceptable to our patients.
Methods Data collated from a Two Week Rule (TWR) database at a single centre over a 6-month period. Endoscopy, radiology and histology yield results reviewed for DTT and OPA. Questionnaires sent to DTT patients regarding satisfaction with service. Hospital ethics committee approval was gained. Simple statistical methods applied.
Results 660 data sets reviewed; 335 DDT, 323 OPAs. The average age of those allocated DTT was 67.8 years, 10 years younger than the OPA group. Within the DTT cohort 5.7% had colorectal cancer (average age of 71.2 years). Majority were at an early stage in comparison to OPA cohort (Dukes A 10.5%, B 54.5%, C 18%, D 9% vs 5%, 20%, 30%, 45% respectively). The predominant symptom was rectal bleeding (52.6%). The main diagnosis for DTT was colonic polyps (21.2%). The average time to investigation 11.5 days, 16.6 days to histological diagnosis. 10.5% of OPA group had cancer but 3% were non-colorectal cancer; half were pancreatic cancer presenting with loose stools and weight loss. Cancer diagnosis was at a later stage, many inoperable. 47% diagnosed with CT as first line investigation. 85% were satisfied with the DTT.
Conclusion The DTT system is an effective efficient service for the younger cohort of patient with red flag symptoms of colorectal cancer. This service can accurately and rapidly diagnose colorectal cancers so that further management can be quickly initiated, meeting national TWR targets. Polyps, precursors to malignancy, the commonest aetiology, maybe treated effectively during investigation. This service could reduce the burden on lower GI outpatient clinics, offering financial benefits and cut down waiting times. In addition, this novel study demonstrates that DTT is highly acceptable to patients. Success depends on an accurate referral by primary care with good communication between GP, specialist care and the patient and it must be emphasised to primary care and to the patient that further investigations maybe warranted following normal endoscopy.
Competing interests None declared.
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