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Abstract
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic.
Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes.
Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma.
Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway.
- COLORECTAL CANCER
- COLONOSCOPY
- RADIOLOGY
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
X @drgauravbnigam, @Laween_Meran, @BrianDNicholson
GBN and LM contributed equally.
Contributors GBN made equal contributions to the conceptualisation, provided supporting assistance for data curation, assumed the lead role in formal analysis, took the lead in writing the original draft as well as overseeing the review and editing process and is responsible for the overall content as the guarantor. LM also made equal contributions to the conceptualisation, assumed the lead role in data curation, provided supporting assistance in writing the original draft, and contributed to the review and editing. IB made equal contributions to data collection and provided supporting contributions to the writing, review and editing process. SE, RM, NC, JP and CM made equal contributions to data collection and contributed to the final version of the manuscript. BS and TJ contributed to the review and editing of the manuscript, providing critical inputs on methodology. BDN and JEE contributed to the conceptualisation as well as the writing, review and editing process. RMP took the lead in conceptualisation, made equal contributions to data collection and provided supporting contributions to the writing, review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.
Competing interests GBN is funded by the National Institute for Health and Care Research (NIHR) (grant number 302607) for a doctoral research fellowship. JEE is funded by the NIHR Oxford Biomedical Research Centre.
Provenance and peer review Not commissioned; externally peer reviewed.
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