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; Merel M Pannebakker; Max J Tagg; Hugo Walford; Peter Holloway; Niek de Wit; Willie Hamilton; Fiona M Walter

doi:10.1136/bmjopen-2022-066051

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

BMJ Open. 2022 Sep 19;12(9):e066051. doi: 10.1136/bmjopen-2022-066051.

Authors

Natalia Calanzani¹, Merel M Pannebakker², Max J Tagg³, Hugo Walford⁴, Peter Holloway⁵, Niek de Wit⁶, Willie Hamilton⁷, Fiona M Walter^{2

8}

Affiliations

¹ The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK nm719@medschl.cam.ac.uk.
² The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
⁴ School of Clinical Medicine, University College London, London, UK.
⁵ East of England Cancer Alliances, Cambridge, UK.
⁶ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.
⁷ University of Exeter Medical School, University of Exeter, Exeter, UK.
⁸ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.

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.

Keywords: Adult oncology; Gastrointestinal tumours; PRIMARY CARE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colorectal Neoplasms* / diagnosis
Fatigue
Female
General Practice*
Humans
Male
Occult Blood
Sensitivity and Specificity