Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study


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Abstract

jats:secjats:titleObjectives</jats:title>jats:pThe faecal immunochemical test (FIT) was introduced to triage patients with lower-risk symptoms of colorectal cancer (CRC) in English primary care in 2018. While there is growing evidence on its utility to triage patients in this setting, evidence is still limited on how official FIT guidance is being used, for which patients and for what symptoms. We aimed to investigate the use of FIT in primary care practice for lower-risk patients who did not immediately meet criteria for urgent referral.</jats:p></jats:sec>jats:secjats:titleDesign</jats:title>jats:pA prospective, descriptive study of symptomatic patients offered a FIT in primary care between January and June 2020.</jats:p></jats:sec>jats:secjats:titleSetting</jats:title>jats:pEast of England general practices.</jats:p></jats:sec>jats:secjats:titleParticipants</jats:title>jats:pConsenting patients (aged ≥40 years) who were seen by their general practitioners (GPs) with symptoms of possible CRC for whom a FIT was requested. We excluded patients receiving a FIT for asymptomatic screening purposes, or patients deemed by GPs as lacking capacity for informed consent. Data were obtained via patient questionnaire, medical and laboratory records.</jats:p></jats:sec>jats:secjats:titlePrimary and secondary outcome measures</jats:title>jats:pFIT results (10 µg Hb/g faeces defined a positive result); patient sociodemographic and clinical characteristics; patient-reported and GP-recorded symptoms, symptom severity and symptom agreement between patient and GP (% and kappa statistics).</jats:p></jats:sec>jats:secjats:titleResults</jats:title>jats:pComplete data were available for 310 patients, median age 70 (IQR 61–77) years, 53% female and 23% FIT positive. Patients most commonly reported change in bowel habit (69%) and fatigue (57%), while GPs most commonly recorded abdominal pain (25%) and change in bowel habit (24%). Symptom agreement ranged from 44% (fatigue) to 80% (unexplained weight loss). Kappa agreement was universally low across symptoms.</jats:p></jats:sec>jats:secjats:titleConclusion</jats:title>jats:pAlmost a quarter of this primary care cohort of symptomatic patients with FIT testing were found to be positive. However, there was low agreement between patient-reported and GP-recorded symptoms. This may impact cancer risk assessment and optimal patient management in primary care.</jats:p></jats:sec>

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Peer reviewed: True


Acknowledgements: We thank all the patients who agreed to take part in the study, and who completed the questionnaire. We thank the general practice staff who provided us with patient outcome data. We thank Allison Chipchase, Eve Calderbank and Claire Corbett for their help obtaining historical data. We thank the North East Essex and Suffolk Pathology Services at the East Suffolk and North Essex NHS Foundation Trust, and the Clinical Biochemistry section of Laboratory Medicine at Norfolk and Norwich University Hospitals NHS Foundation Trust for all their help providing laboratory data. We are grateful to Dr Marije van Melle for her work in the early stages of study design, and to Dr Sarah ER Bailey for her help during protocol development. We are grateful to Dr Lina Massou for expert statistical input. We thank Aina Chang and Sara Shaida for their help with data collection and gathering background information for the study, and James Brimicombe for data management advice, support and expertise. We are indebted to Andy Cowan for his invaluable support collecting and managing study data, and for his comments on the study results. We also thank Victoria Hardy, Dr Owain T Jones and Dr Yin Zhou for their comments on the study results.

Keywords
General practice / Family practice, 1506, 1696, Adult oncology, Gastrointestinal tumours, PRIMARY CARE
Journal Title
BMJ Open
Conference Name
Journal ISSN
2044-6055
2044-6055
Volume Title
Publisher
BMJ
Sponsorship
Cancer Research UK (C8640/A23385)