Outcomes from colonoscopy following referral from New Zealand general practice

Making Education Easy

Authors:

Lawrenson R et al.

January 27, 2022

Summary:

In a study of Waikato DHB data, the likelihood of colorectal cancer in patients undergoing colonoscopy following GP referral with a high suspicion of cancer (HSCan) was almost 15%. The study authors suggested that such patients should be routinely prioritised without further triage by the hospital. They assessed e-referral data for patients aged at least 30 years referred from 75 general practices to general surgery, gastroenterology or direct to colonoscopy between 1 January 2015 and 31 December 2017. A total of 6718/20648 (32.5%) patients underwent colonoscopy, of whom 372 (5.5%) were diagnosed with colorectal cancer. Females, non-Māori, and patients with a HSCan label originating from their GP were more likely to have a colonoscopy. Among the 585 patients with a GP HSCan label who underwent colonoscopy, the odds ratio of a colorectal cancer diagnosis 2.34 (95% CI 1.70-3.22). However, 423 of these patients were reprioritised by the hospital and 55 had their diagnosis unnecessarily delayed.

Comment:

Given our recent lockdowns, and now long waiting lists for investigations, I agree with the recommendation to prioritise GP referred patients without further hospital triaging. And given the significant disparities in colon cancer survival between Māori and non-Māori, an equity approach must also be prioritised.

Reference: BMC Gastroenterol. 2021;21(1):471.

Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.