ThP6.18 - 2 week wait referrals for suspected colorectal cancer in patients more than 85 years old. How many actually end up on the operating table?

Abstract Aims To assess the outcomes of 2 week wait referrals for patients > 85 years old for suspected colorectal cancer in a large university hospital Methods Retrospective review of records of patients >85years old referred on the pathway between September to November 2023. Outcomes assessed were the number of patients that underwent investigation, cancers detected and whether they ended up having surgery. Results 211 patients were referred. 43 were not investigated (20.4%), 95 had CT-colons (45%), 37 had CT-abdomen, 25 had flexible-sigmoidoscopy, 15 had CT Chest-abdomen-pelvis, only 10 had a colonoscopy (4.7%). 13 colorectal cancers were diagnosed (6.2%). Out of these only 3 agreed and were fit to proceed with surgery, 7 refused surgery and 2 were undecided while 1 passed away 2 weeks after the diagnosis was made. 5 incidental extracolonic cancers were diagnosed (2 pancreatic, 2 renal and 1 lung, 2 of which were metastatic) All the diagnosed colorectal cancers were FIT positive (100% sensitivity). 7 had no FIT test done and 14 were FIT negative. Conclusion The incidence of colorectal cancers in this group of patients is relatively small and most end up being not fit for investigation or surgery or refusing it themselves even when cancer is diagnosed. These patients should still have the right to be investigated and treated if they wish to but a pragmatic discussion needs to be made with them by the referring clinician before a referral is made as well as making use of the very high sensitivity of FIT testing to ensure optimal use is made of the limited resources available in our already stretched system.