PO557 Faecal immunochemical test (FIT) in secondary care: Prioritising lower GI two week wait patients during the COVID-19 pandemic

Published Date: 11th October 2021

Publication Authors: Bassi A

Introduction
FIT provides a safe, rapid and accurate way to determine a patient’s risk of having a lower GI cancer and it may possibly be used to exclude cancer for patients with negative result. It will reduce primary care referrals by enabling GPs to determine likelihood of lower GI cancer before referral whilst adhering with UK NICE guidance and enable clinicians to triage patients referred on the rapid access suspected caner pathway for endoscopy.

This study is an interim report of the work performed by the Cheshire and Merseyside Cancer Alliance (CMCA), which covers a population of 2.5 million, looking at the use of FIT testing for prioritising patients with suspected cancer during the COVID pandemic when standard pathways were not possible.

Aims & Methods
During the initial phase of the COVID19 pandemic, non-essential endoscopy services were halted. As a result, by May 2020, there were over 1,400 lower GI suspected cancer referrals on hold.

Furthermore, an estimated 4,500 lower GI suspected cancer referrals were expected due to patients not visiting their GP during the pandemic. CMCA worked with seven hospital sites over eight weeks to implement a secondary care-based FIT system to prioritise eligible lower GI 2WW patients for investigation. Two CMCA FIT pilot studies carried out to prior to final implementation plan. Patients who were referred via the 2WW lower GI cancer service with symptoms that met NICE guidance referral criteria were given FIT test as primary investigation. Rectal bleeding and abdominal/rectal mass were excluded from this pathway.

Following the result patients were prioritised into 3 groups (1a (positive) Iron Deficiency Anaemia (IDA) or >100µg, 1b (positive) 10-99µg and 1c (negative) <10µg no IDA). Groups 1a and 1b were triaged to urgent investigations and 1c safety netted and kept on a patient tracking list. All 6 sites were tasked to collect data on a minimum data set to ensure concordance.

Results
1567 patients underwent FIT test till date with (mean age 68). 32% (n=497) of patients had a FIT result less than 10ug and no IDA, resulting in transfer from a 2WW to a routine pathway. 30% (n=471) of patients tested had a FIT result greater than or equal to 10ug. Such patients have at least a 4.8% risk of colorectal cancer and were prioritised for investigation. Of these patients, 9% (n=135) had a FIT result ≥ 100ug, indicating urgent investigation needed. 32 cancers were diagnosed, representing 2.0% of all patients. Of these cancers, 25 were colorectal cancers (1.6%) and seven non GI cancers. All 25 colorectal cancers were found in patients with FIT≥10ug. For patients with FIT > 100µg and 10-99µg, the pickup rate of bowel malignancy was 7.4 % and 2.1% respectively.

Only 12% of colorectal cancers were found at an early stage (1 or 2) and only 18 of 25 cancers had a known stage, however numbers were small. Within 6 weeks of implementation, secondary care FIT for high risk patients during the COVID19 lockdown resulted in a substantial reduction in the numbers of suspended lower GI TWW referrals.

Conclusions
During the COVID pandemic FIT has been a useful tool to help reduce the backlog of 2ww lower GI referrals and helped to prioritise endoscopic examinations needed. This has saved money and has provided the ability to discharge low risk patients back to primary care while decreasing the wait for patients needing colonoscopy. More studies are required to ensure that discharged patients remained cancer free, cost effectiveness of FIT nationally and the effect of medication upon the sensitivity/specificity of FIT.

 

Kearsey, C; Bassi, A. (2021). PO557 Faecal immunochemical test (FIT) in secondary care: Prioritising lower GI two week wait patients during the COVID-19 pandemic. United European Gastroenterology Journal. 9 (S8), 606-607

 

 

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