FIT for Frailty? An evaluation of a new geriatric clinic in the 2WW Lower GI Pathway

Introduction

The burden of colorectal cancer (CRC) falls disproportionately on older adults in the UK (1-2). The current straight-to-test 2-week wait (2WW) lower GI pathway may not adequately assess older patients for their suitability for invasive initial investigations (3-5). 

Previous initiatives introducing a geriatric service as the first line of contact in this pathway demonstrated holistic shared decision-making with referred patients (4-5). This retrospective audit will evaluate if a similar service improvement project at Broomfield Hospital shared similar successes. 

Methods

A retrospective audit of the GP referral forms and geriatric clinic letters on the Lorenzo database, from February to October 2025, for the 2WW lower GI pathway, was conducted to assess if initial management plans were tailored according to patient wishes and frailty levels. We also evaluated if patient deaths and CRC diagnosis remained at an acceptable level. 

Results

We analysed a total of 629 (278 male, 351 female) referrals to the geriatric clinic. 

Patients who scored lower on the Clinical Frailty Score (CFS), at 1-3, were more likely to receive colonoscopies (41.50%) than no investigations (5.66%). Patients with advanced frailty (CFS 7-9), were more likely to receive no investigations (51.79%), and none of them received colonoscopies. 

The most common reasons for patients to receive no initial investigations were having no red flags or recent reassuring CT scans. Personal choice not to investigate and advanced frailty were the other reasons.  

The overall CRC pickup rate was 4.29% and the CRC-related mortality rate was 0.48%. 

Overall, CT Colon was the preferred investigation modality, picking up incidental non-colorectal cancers. 

Conclusion

This novel clinic service uses a patient-centred approach to tailor initial investigations according to CFS and shared decision-making, avoiding unnecessary management, while maintaining an acceptable cancer detection and CRC mortality rate. This approach had an added benefit of picking up non-colorectal cancers. 

References

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2. Luo, S., Gong, J., Zhu, Y., Wang, L., & Zhang, K. (2025). Global, regional, and national burden of colorectal cancer in the elderly (aged > 60 years): a comprehensive analysis across 204 countries and territories (1990-2021) . BMC gastroenterology, 25(1), 570. https://doi.org/10.1186/s12876-025-04184-4

3. O'Donnell, C. D. J., Hubbard, J., & Jin, Z. (2024). Updates on the Management of Colorectal Cancer in Older Adults. Cancers, 16(10), 1820. https://doi.org/10.3390/cancers16101820

4. Nixon, A., Memery, T., Morgan, J., Brown, A., & Scampion, C. (2024). Developing a pathway direct to elderly medicine clinic for frail patients referred via colorectal fast-track: Pilot and outcomes. Age and Ageing, 53(Suppl 1), afad246.001. https://doi.org/10.1093/ageing/afad246.001 

5. Dinsdale, E., Whitehead, K., Gould, D., Miller, C., & Nair, S. (2024). Development of a novel 2-week wait oncogeriatric service: A GI frailty clinic. Age and Ageing, 53(Suppl 1), afad246.037. https://doi.org/10.1093/ageing/afad246.037