# Evaluation of Patients With Iron Deficiency Anaemia Referred via the Colorectal Cancer Two-Week Pathway in a District General Hospital: A Retrospective Cohort Study

## TL;DR

This study examines how patients with iron deficiency anemia referred for possible colorectal cancer are evaluated in a hospital, finding that most had non-cancer issues and suggesting better risk tools are needed.

## Contribution

The study provides insights into the efficiency and outcomes of a nurse-led triage system for IDA patients in a district hospital setting.

## Key findings

- Only 2% of patients had colorectal cancer, while 12% had inflammatory bowel or coeliac disease.
- Most patients (70%) were discharged after reassurance, indicating low malignancy yield.
- Specialist nurse triage helped optimise endoscopy and outpatient resource use.

## Abstract

Background

Iron deficiency anaemia (IDA) is a frequent clinical presentation in both primary and secondary care and is a recognised red-flag symptom for underlying gastrointestinal malignancy, particularly colorectal cancer. Prompt and efficient investigation is essential to identify significant pathology while minimising unnecessary procedures.

Objectives

To evaluate the clinical outcomes of patients referred under the two-week wait (2WW) pathway for suspected colorectal cancer due to IDA in a district general hospital setting.

Methods

A retrospective review was conducted of 50 consecutive patients referred with IDA via the 2WW pathway. Data collected included demographics, triage method, investigations undertaken, procedures performed, and final diagnoses.

Results

A total of 50 patients were included. The mean age was 63.2 years (SD ±10.7), and 60% (n=30) of patients were female, while males (40%, n=20) constituted the rest of the cohort. All patients underwent initial triage by a specialist nurse, with 42% (n=21) referred directly for endoscopy, while the remainder (n=29, 58%) were seen in outpatient clinics. Bidirectional endoscopy was performed in 82%-94% of cases, with additional CT imaging in selected patients. Significant findings included one case (n=1, 2%) of colorectal cancer, 12% (n=6) diagnosed with inflammatory bowel disease or coeliac disease, and 8% (n=4) entered polyp surveillance. Most patients (n=35, 70%) were discharged after reassurance.

Conclusions

Structured triage led by specialist nurses enables efficient use of endoscopy and outpatient resources. While the diagnostic yield for malignancy was low (n=1, 2%), a notable proportion of patients had alternative significant findings. These results support a comprehensive diagnostic approach for IDA but highlight the need for improved risk stratification tools to optimise resource utilisation and patient outcomes.