P251 Update – outcomes from a virtual clinic developed to manage GI consequences of colorectal cancer during the COVID-19 pandemic

IntroductionReductions in cancer mortality rates are the result of better screening and the use of improved treatments. Whilst there has been a longstanding awareness of the psychological and social impact of cancer therapy, there has been little emphasis on dealing with the physical symptoms that are a frequent complication of treatment. This can include living with chronic and debilitating bowel symptoms as well as problems with sexual and urinary function. In our hospital, over 400 patients are diagnosed and treated for colorectal cancer annually. Data suggest that up to half, depending on the treatment(s) received, will develop chronic symptoms.MethodsA virtual telephone clinic was set up during the COVID-19 pandemic. Patients requiring gastroenterology review were identified at follow-up by colorectal cancer nurse specialists, colorectal surgeons or oncology specialists. Patients were reviewed by a Gastroenterology Research Fellow via a telephone consultation and investigations requested following a predefined, structured checklist according to their symptoms.Results66 patients (30 male, 36 female), median age 71 (range 40–89) were reviewed between October 2020 to September 2022. The mean duration of symptoms was 33 months (range 4 to 108). All had been diagnosed with colorectal cancer (20 right colon, 10 left colon and 36 rectum). Previous treatment included surgery (n=31), surgery + chemotherapy (n=13), surgery + radiotherapy (n=4), surgery + radiotherapy + chemotherapy (n=13) and radiotherapy + chemotherapy (n=5).Patients’ symptoms pre-referral and after treatment were assessed objectively using the gastrointestinal symptoms rating scale (GSRS), with a mean GSRS on referral of 25, improving to 16 following investigation and treatment. 10 different symptoms were identified in patients (loose stool (n=45), bloating/wind (n=31), frequency (n=31), urge (n=28), incontinence (n=19), constipation (n=14), abdominal/rectal pain (n=13), mucous discharge (n=6), nocturnal symptoms (n=6) and rectal bleeding (n=1)). Diagnoses made are shown in table 1. The mean overall package of care cost £803.53 (range £86.83 - £1778.49)/patient.ConclusionsIn most patients referred to our specialist clinic, one or more causes for their symptoms were identified. Treatment frequently lead to a dramatic improvement in symptoms. Future recommendations include earlier recognition of patients in need of specialist referral through the use of objective questionnaires. Results from a