SP3.2 - Investigating pre-operative anaemia optimisation in patients on the colorectal cancer pathway

Abstract Aims Colorectal cancer (CRC) is becoming increasingly prevalent in the United Kingdom, with over 42,000 cases diagnosed every year. CRC is most commonly diagnosed at colonoscopy. Patients are often found to have iron deficiency anaemia during pre-assessment and may require intravenous iron (IVI) replacement for preoperative optimisation. Our aim was to determine the percentage of patients on the CRC pathway requiring optimisation of anaemia and to review the pathway for patients requiring IVI preoperatively, to identify opportunities for improvements. Methods This study investigated 85 patients who were referred to the pre-assessment clinic (PAC) under the CRC pathway. The percentage of patients requiring IVI to optimise their anaemia was identified. The time taken to refer patients for IVI, and the time taken to infusion appointment was then established. Results This study found 24% of patients were anaemic, with 12% showing severe anaemia requiring IVI. The average waiting time between colonoscopy and PAC review was 24 days. Patients requiring IVI waited a further 8 days on average to be referred for replacement. There was a delay of 10 days from referral for iron before patients were given the first dose of iron, with patients waiting up to 4 weeks before the course of intravenous iron was complete. Discussion Patients on the CRC pathway currently face significant delays in optimising iron deficiency anaemia pre-operatively. Investigating patients for anaemia at the time of colonoscopy and referring for iron replacement earlier could reduce this delay and ensure patients are optimised in a timely manner for surgery.