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. 2020 Jun;22(6):679-688.
doi: 10.1111/codi.14944. Epub 2020 Jan 29.

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

C Chapman  1 , C Thomas  2 , J Morling  1   3   4 , A Tangri  5 , S Oliver  6 , J A Simpson  2 , D J Humes  2   3   4 , A Banerjea  1
Affiliations

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

C Chapman et al. Colorectal Dis. 2020 Jun.

Abstract

Aim: We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach.

Method: FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018.

Results: Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P < 0.0001). FIT results ≥ 10.0 μg Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi-square 73.6, P < 0.0001) and FIT results < 4.0 μg Hb/g faeces identified a group more likely to have non-CRC pathology (5.1% vs 2.4%, chi-square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 μg Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 μg Hb/g faeces had sensitivity 97.2% (85.5-99.9% CI), specificity 61.4% (58.1-64.7% CI), negative predictive value 99.8% (98.7-100.0% CI) and positive predictive value 9.5% (8.7-10.4% CI).

Conclusion: A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone.

Keywords: Colorectal cancer; Faecal immunochemical test (FIT); diagnosis; stratification of cancer risk.

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References

    1. Cancer Research UK. Cancer Statistics/Bowel Cancer, 2016. http://www.cancerresearchuk.org/health-professional/cancer-statistics/st... (accessed January 2019).
    1. Chohan DP, Goodwin K, Wilkinson S, Miller R, Hall NR. How has the 'two-week wait' rule affected the presentation of colorectal cancer? Colorectal Dis 2005; 7: 450-3.
    1. Leung E, Grainger J, Bandla N, Wong L. The effectiveness of the '2-week wait' referral service for colorectal cancer. Int J Clin Pract 2010; 64: 1671-4.
    1. Debnath D, Dielehner N, Gunning KA. Guidelines, compliance, and effectiveness: a 12 months' audit in an acute district general healthcare trust on the two week rule for suspected colorectal cancer. Postgrad Med J 2002; 78: 748-51.
    1. Thorne K, Hutchings HA, Elwyn G. The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: a systematic literature review. BMC Health Serv Res 2006; 6: 43.

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