RT Journal Article
SR Electronic
T1 Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e066051
DO 10.1136/bmjopen-2022-066051
VO 12
IS 9
A1 Natalia Calanzani
A1 Merel M Pannebakker
A1 Max J Tagg
A1 Hugo Walford
A1 Peter Holloway
A1 Niek de Wit
A1 Willie Hamilton
A1 Fiona M Walter
YR 2022
UL http://bmjopen.bmj.com/content/12/9/e066051.abstract
AB 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.Data are available upon reasonable request.