GP access to FIT increases the proportion of colorectal cancers detected on urgent pathways in symptomatic patients in Nottingham

Bailey, J.A.; Khawaja, A.; Andrews, H.; Weller, J.; Chapman, C.; Morling, J.; Oliver, S.; Castle, S.; Simpson, J.A.; Humes, D.J.; Banerjea, A.

Abstract

Objective
Service evaluation of GP access to Faecal Immunochemical Test (FIT) for colorectal cancer (CRC) detection in Nottinghamshire and use of FIT for “rule out”, “rule in” and “first test selection”.

Design
Retrospective audit of FIT results, CRC outcomes and resource utilisation before and after introduction of FIT in Primary Care in November 2017. Data from the new pathway up to December 2018 was compared with previous experience.

Results
Between November 2017 and December 2018, 6747 GP FIT test requests yielded 5733 FIT results, of which 4082 (71.2%) were [less than]4.0 μg Hb/g faeces, 579 (10.1%) were 4.0–9.9 μg Hb/g faeces, 836 (14.6%) were 10.0–149.9 μg Hb/g faeces, and 236 (4.1%) were ≥150.0 μg Hb/g faeces. The proportion of “rule out” results [less than]4.0 μg Hb/g faeces was significantly higher than in the Getting FIT cohort (71.2% vs 60.4%, Chi squared 42.8, p [less than] 0.0001) and the proportion of “rule in” results ≥150.0 μg Hb/g faeces was significantly lower (4.1% vs 8.1%, Chi squared 27.3,P [less than] 0.0001).
There was a 33% rise in urgent referrals across Nottingham overall during the evaluation period. 2 CRC diagnoses were made in 4082 patients who had FIT[less than]4.0 μg Hb/g faeces. 58.4% of new CRC diagnoses associated with a positive FIT were early stage cancers (Stage I and II). The proportion of all CRC diagnoses that follow an urgent referral s rose after introduction of FIT.

Conclusions
FIT allows GP's to select a more appropriate cohort for urgent investigation without a large number of missed diagnoses. FIT appears to promise a “stage migration” effect which may ultimately improve CRC outcomes.

Citation

Bailey, J., Khawaja, A., Andrews, H., Weller, J., Chapman, C., Morling, J., Oliver, S., Castle, S., Simpson, J., Humes, D., & Banerjea, A. (2021). GP access to FIT increases the proportion of colorectal cancers detected on urgent pathways in symptomatic patients in Nottingham. The Surgeon, 19(2), 93-102. https://doi.org/10.1016/j.surge.2020.03.002

• Journal Article Type: Article
• Acceptance Date: Mar 23, 2020
• Online Publication Date: Apr 20, 2020
• Publication Date: 2021-04
• Deposit Date: Apr 22, 2020
• Publicly Available Date: Apr 21, 2021
• Journal: The Surgeon
• Print ISSN: 1479-666X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 2
• Pages: 93-102
• DOI: https://doi.org/10.1016/j.surge.2020.03.002
• Keywords: Surgery
• Public URL: https://nottingham-repository.worktribe.com/output/4325812
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S1479666X20300445