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

Natalia Calanzani* (Corresponding Author), Merel M Pannebakker, Max J Tagg, Hugo Walford, Peter Holloway, Niek de Wit, Willie Hamilton, Fiona M Walter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objectives The 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.

Design A prospective, descriptive study of symptomatic patients offered a FIT in primary care between January and June 2020.

Setting East of England general practices.

Participants Consenting 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.

Primary and secondary outcome measures FIT 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).

Results Complete 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.

Conclusion Almost 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.
Original languageEnglish
Article numbere066051
Number of pages9
JournalBMJ Open
Volume12
Issue number9
Early online date19 Sept 2022
DOIs
Publication statusPublished - 19 Sept 2022

Bibliographical note

Funding
This research arises from the CanTest Collaborative, which is funded by Cancer Research (UK C8640/A23385), of which FMW and WH are Directors, NdW is an Associate Director, NC and MMP are postdoctoral researchers

Data Availability Statement

Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

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